# Health - General (GHG)

## Title 10. Mental Health Law

### Subtitle 7. Rights of Mentally Ill Individuals in Facilities

#### Section 10-701

(a)

  (1) In this subtitle the following words have the meanings indicated.

  (2)

    (i) "Advocate" means a person who provides support and guidance to an individual in a facility.

    (ii) "Advocate" includes a family member or friend.

    (iii) "Advocate" does not include an attorney acting in the capacity of legal counsel to an individual in a facility during the treatment planning and discharge planning process.

  (3) "Facility" does not include an acute general care hospital that does not have a separately identified inpatient psychiatric service.

  (4)

    (i) "Mental abuse" means any persistent course of conduct resulting in or maliciously intended to produce emotional harm.

    (ii) "Mental abuse" does not include the performance of an accepted clinical procedure.

  (5)

    (i) "Prone restraint" means restricting the free movement of all or a portion of an individual's body through the use of physical force or mechanical devices while the individual is in a prone position.

    (ii) "Prone restraint" does not include a technique for transitioning an individual to a restraint position that involves momentarily placing the individual face down.

  (6) "State facility" means an inpatient facility that is maintained under the direction of the Behavioral Health Administration.

  (7) "Trauma-informed care" means mental health treatment that includes:

    (i) An appreciation for the high prevalence of trauma experienced by individuals receiving mental health services;

    (ii) An understanding of the neurological, biological, psychological, and social effects of trauma and violence, including sexual abuse and exploitation, on an individual; and

    (iii) An understanding of the environment, practices, and treatments that may need to be modified to address trauma issues.

(b) It is the policy of this State that each individual with a mental disorder who receives any service in a facility has, in addition to any other rights, the rights provided in this subtitle.

(c) Each individual in a facility shall:

  (1) Receive appropriate humane treatment and services in a manner that restricts the individual's personal liberty within a facility only to the extent necessary and consistent with the individual's treatment needs and applicable legal requirements;

  (2) Receive treatment in accordance with the applicable individualized plan of rehabilitation or the individualized treatment plan provided for in Sec. 10-706 of this subtitle;

  (3) Be free from restraints or seclusions except for restraints or seclusions that are:

    (i) Used only during an emergency in which the behavior of the individual places the individual or others at serious threat of violence or injury; and

    (ii)

      (1) Ordered by a physician in writing; or

      (2) Directed by a registered nurse if a physician's order is obtained within 2 hours of the action;

  (4) Be free from prone restraint;

  (5) Be free from restraint that:

    (i) Applies pressure to the individual's back;

    (ii) Obstructs the airway of the individual or impairs the individual's ability to breathe;

    (iii) Obstructs a staff member's view of the individual's face; or

    (iv) Restricts the individual's ability to communicate distress;

  (6) Be free from mental abuse;

  (7) Be protected from harm or abuse as provided in this subtitle;

  (8) Except as provided in subsection (e) of this section, and subject to subsection (k) of this section, have the right to an advocate of the individual's choice to participate in the treatment planning and discharge planning process; and

  (9) Subject to the provisions of Sec. 10-708 of this subtitle, if the individual has an advance directive for mental health services provided for in Sec. 5-602.1 of this article, receive treatment in accordance with the preferences in the advance directive.

(d) A State facility shall ensure that:

  (1) All clinical, direct care, and other designated staff with regular patient interaction receive training in trauma-informed care and demonstrate competency in providing trauma-informed care services within 3 months of being hired and on an annual basis;

  (2) Any policy or practice followed by the facility is reviewed and revised to conform with trauma-informed care principles; and

  (3) The physical environment of the facility is assessed at least annually and modified if the modifications:

    (i) Are necessary to ensure conformity with trauma-informed care principles; and

    (ii) Can be funded through the State's operating budget or capital budget.

(e) Notwithstanding the provisions of subsection (c)(8) of this section, a facility may prohibit an advocate from participating in the treatment planning or discharge planning process for an individual if:

  (1)

    (i) The individual is a minor or an adult under guardianship in accordance with Sec. 13-705 of the Estates and Trusts Article; and

    (ii) The parent of the minor or the legal guardian of the individual has requested that the advocate not participate; or

  (2) The advocate has engaged in behavior that:

    (i) Is disruptive to the individual, other patients, or staff at the facility; or

    (ii) Poses a threat to the safety of the individual, other patients, or staff at the facility.

(f) A facility shall:

  (1) Have a written policy specifying the method used to ensure that an individual whose primary language or method of communication is nonverbal is able to effectively communicate distress during a physical restraint or hold; and

  (2) Ensure that all staff at the facility who are authorized to participate in a physical restraint or hold of individuals are trained in the method specified in the written policy required under item (1) of this subsection.

(g) Subject to the provisions of Sec.Sec. 4-301 through 4-309 of this article, the records of each individual in a facility are confidential.

(h)

  (1) Notwithstanding any other provision of law, when the State designated protection and advocacy agency has received and documented a request for an investigation of a possible violation of the rights of an individual in a facility that is owned and operated by the Department or under contract to the Department to provide mental health services in the community under this subtitle, the executive director of the protection and advocacy agency or the executive director's designee:

    (i) Before pursuing any investigation:

      (1) Shall interview the individual whose rights have been allegedly violated; and

      (2) Shall attempt to obtain written consent from the individual; and

    (ii) If the individual is unable to give written consent but does not object to the investigation:

      (1) Shall document this fact; and

      (2) Shall request, in writing, access to the individual's records from the Director of the Behavioral Health Administration.

  (2) On receipt of the request for access to the individual's records, the Director of the Behavioral Health Administration shall authorize access to the individual's records.

  (3) After satisfying the provisions of paragraphs (1) and (2) of this subsection, the executive director of the protection and advocacy agency, or the executive director's designee, may pursue an investigation and, as part of that investigation, shall continue to have access to the records of the individual whose rights have been allegedly violated.

(i)

  (1) On admission to a facility, an individual shall be informed of the rights provided in this subtitle in language and terms that are appropriate to the individual's condition and ability to understand.

  (2) A facility shall post notices in locations accessible to the individual and to visitors describing the rights provided in this subtitle in language and terms that may be readily understood.

(j) A facility shall implement an impartial, timely complaint procedure that affords an individual the ability to exercise the rights provided in this subtitle.

(k) This section may not be construed to:

  (1) Grant the advocate of an individual legal authority that the advocate does not otherwise have under law to make decisions on behalf of the individual regarding treatment or discharge;

  (2) Grant the advocate access to the medical records of the individual or other confidential information that the advocate does not otherwise have access to under law; or

  (3) Limit the legal authority that an attorney or other person otherwise has under law to participate in the treatment planning and discharge planning process or to otherwise act on behalf of an individual in a facility.

#### Section 10-702

(a)

  (1) Subject to any reasonable limitation that a facility imposes, each individual in the facility shall have access, at all reasonable hours, to writing instruments, stationery, and postage and may use them to write to anyone.

  (2) The correspondence of the individual shall be sent to the addressee without delay, and except under the direction of the addressee, without being opened.

(b) Each individual in a facility shall have reasonable access to a telephone. However, an individual may not telephone anyone who has given the facility written notice of being unwilling to be telephoned.

(c)

  (1) If, for medical reasons, an individual's access to correspondence, writing instruments, or telephones is limited, the limitation shall be:

    (i) Signed by a physician and the reasons for the limitation and the date on which the limitation expires made a permanent part of the individual's record; and

    (ii) Reviewed every 30 days if the limitation remains in effect.

  (2) If the attending physician believes that, because of the condition of an individual, another individual should be permitted to be present when writing instruments are used, the permission and the reasons for the permission shall be:

    (i) Signed by the attending physician;

    (ii) Dated as to when the permission expires;

    (iii) Made a permanent part of the individual's record; and

    (iv) Reviewed every 30 days if the permission remains in effect.

#### Section 10-703

(a) Each individual in a facility shall be entitled to converse privately with and receive visits:

  (1) At all reasonable hours, from a lawyer that the individual chooses;

  (2) At all reasonable hours, from a clergyman that the individual chooses; and

  (3) During reasonable visiting hours that the facility sets, from any other visitor if the individual wishes to see the visitor.

(b) If an individual refuses to see a visitor, the refusal shall be made a permanent part of the individual's record.

(c)

  (1) If, for medically justified reasons, visits or private conversations are restricted, the restriction and the reasons for the restriction shall be:

    (i) Signed by a physician;

    (ii) Dated as to when the restriction expires;

    (iii) Made a permanent part of the individual's record; and

    (iv) Reviewed every 30 days if the restriction remains in effect.

  (2) Visits of an individual's lawyer or clergyman may not be restricted during reasonable hours.

#### Section 10-704

An individual may not be deprived of the right to vote or to receive, hold, and dispose of property solely because the individual is in a facility or a Veterans' Administration hospital for a mental disorder.

#### Section 10-705

(a)

  (1) In this section the following words have the meanings indicated.

  (2)

    (i) "Abuse" means cruel or inhumane treatment that causes:

      (1) Any physical injury; or

      (2) Any of the following kinds of sexual abuse:

      (A) A sexual act, as defined in Sec. 3-301 of the Criminal Law Article;

      (B) Sexual contact, as defined in Sec. 3-301 of the Criminal Law Article; or

      (C) Vaginal intercourse, as defined in Sec. 3-301 of the Criminal Law Article.

    (ii) "Abuse" does not include:

      (1) The performance of an accepted medical procedure that a physician orders in a manner that is consistent with the provisions of this subtitle; or

      (2) An action taken by an employee that complies with applicable State and federal laws and applicable Department policies on the use of physical intervention.

  (3) "Sexual harassment" means intimidation, bullying, or coercion of a sexual nature or unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature that tends to create a hostile or offensive environment.

(b)

  (1) A person or any employee of a facility or of the Department who receives a complaint of abuse, or who observes or has reason to believe that abuse has occurred, shall promptly report the alleged abuse to:

    (i) An appropriate law enforcement agency; or

    (ii) The administrative head of the facility, who promptly shall report the alleged abuse to an appropriate law enforcement agency.

  (2) A report:

    (i) May be oral or written; and

    (ii) Shall contain as much information as the reporter is able to provide.

  (3) Within 24 hours after receiving the complaint, a facility that is a licensed residential treatment center, a State facility, or a hospital with a separately identified inpatient psychiatric service shall report a complaint of sexual abuse or sexual harassment of a patient receiving treatment in the residential treatment center or receiving inpatient psychiatric services to:

    (i) The Administration and the Office of Health Care Quality;

    (ii) If the complaint involves a minor, the Child Protective Services unit in the Department of Human Services; and

    (iii) The State designated protection and advocacy system.

  (4) The Administration and the Office of Health Care Quality shall collaborate to develop and implement a uniform reporting system to be used by facilities in complying with paragraph (3) of this subsection.

(c)

  (1) The law enforcement agency shall:

    (i) Investigate thoroughly each report of an alleged abuse; and

    (ii) Attempt to ensure the protection of the alleged victim.

  (2) The investigation shall include:

    (i) A determination of the nature, extent, and cause of the abuse, if any;

    (ii) The identity of the alleged abuser; and

    (iii) Any other pertinent fact or matter.

(d) As soon as possible, but no later than 10 working days after the completion of the investigation, the law enforcement agency shall submit a written report of its findings to the State's Attorney, the State designated protection and advocacy system, and the administrative head of the facility.

(e) A person shall have the immunity from liability described under Sec. 5-626 of the Courts Article for:

  (1) Making a report under this section;

  (2) Participating in an investigation arising out of a report under this section; or

  (3) Participating in a judicial proceeding arising out of a report under this section.

(f)

  (1) A facility that is a licensed residential treatment center, a State facility, or a hospital with a separately identified inpatient psychiatric service shall:

    (i) Develop and implement policies and procedures on making and responding to allegations and complaints of sexual abuse or sexual harassment of patients receiving treatment in the residential treatment center or receiving inpatient psychiatric services;

    (ii) Ensure that staff provide assistance to patients who have requested assistance in making complaints about sexual abuse or sexual harassment;

    (iii) Develop and oversee training for staff on how to identify and prevent sexual abuse and sexual harassment, how to respond to complaints, and how to support victims in an appropriate manner; and

    (iv) Develop and oversee patient education on identifying sexual abuse and sexual harassment and on reporting incidents of sexual abuse and sexual harassment.

  (2) The Administration shall ensure that the policies and procedures developed and implemented under paragraph (1) of this subsection are uniform for State facilities.

(g) The Administration shall develop and implement a plan to secure the sleeping quarters of male and female patients at all State facilities that maximizes the use of available resources and infrastructure.

(h) Each facility that is a licensed residential treatment center, a State facility, or a hospital with a separately identified inpatient psychiatric service shall, for patients receiving treatment in the residential treatment center or receiving inpatient psychiatric services:

  (1) Use evidence-based screening tools to identify on admission a patient's risk of being a victim of sexual or physical abuse, or being a sexual or physical abuser, and shall consider the assessment of risk in making any unit and room assignment;

  (2) Adopt a written protection plan as part of a patient's treatment plan if warranted by the patient's risk of being a victim of sexual or physical abuse or being a sexual or physical abuser;

  (3) If possible, reassign any patient accused of sexual assault promptly to another unit and ensure that any alleged victim and the alleged assailant are not housed in the same unit;

  (4) Provide a patient who has a history of sexual trauma with treatment and education that is evidence-based or reflective of best practices to reduce the likelihood of the patient being the victim of repeated sexual abuse; and

  (5) Ensure that designated clinical staff are trained in at least one trauma recovery modality that is considered to be a best practice.

(i) The Office of Health Care Quality shall enforce this section.

(j) The Department shall adopt regulations to carry out this section.

#### Section 10-706

(a)

  (1) Except as provided by paragraph (2) of this subsection, promptly after admission of an individual, a facility shall make and periodically update a written plan of treatment for the individual in the facility, in accordance with the provisions of this subtitle.

  (2) Promptly after admission of an individual to a psychosocial center, the center shall make and periodically update a written plan of rehabilitation for the individual in the facility, in accordance with the provisions of this subtitle.

(b) The Director shall adopt rules and regulations under this section that include:

  (1) Subject to subsection (d) of this section, a description of the nature and content of plans of treatment; and

  (2) Subject to subsection (e) of this section, appropriate time periods for the development, implementation, and review of each plan.

(c) An individual shall:

  (1) Participate, in a manner appropriate to the individual's condition, in the development and periodic updating of the plan of treatment; and

  (2) Be told, in appropriate terms and language, of:

    (i) The content and objectives of the plan of treatment;

    (ii) The nature and significant possible adverse effects of recommended treatments;

    (iii) The name, title, and role of personnel directly responsible for carrying out the treatment for the individual; and

    (iv) When appropriate, other available alternative treatments, services, or providers of mental health services.

(d) A plan of treatment shall include:

  (1) A long-range discharge goal; and

  (2) An estimate of the probable length of inpatient stay the individual requires before transfer to a less restrictive or intensive treatment setting.

(e) Facility staff who work directly with and provide treatment to an individual shall review and reassess the plan of treatment for the individual to determine the individual's progress and any need for adjustments to the plan not less than:

  (1) Once every 15 days for the first 2 months after admission of the individual to the facility; and

  (2) Once every 60 days for the remainder of the inpatient stay of the individual in the facility.

(f)

  (1) On the admission of an individual to a facility, the facility shall:

    (i) Ask the individual whether the individual consents to family members or any other individuals being informed of and given the opportunity to participate in meetings with the treatment team regarding the development, review, and reassessment of the plan of treatment of the individual; and

    (ii) If consent is given under item (i) of this paragraph, at least every 7 days after consent is given, reconfirm the consent and provide the individual at a clinical visit with an opportunity to consent to additional individuals being informed of and given the opportunity to participate in meetings with the treatment team.

  (2) If an individual agrees to have family members or other individuals participate in the development, review, and reassessment of the individual's plan of treatment, the facility shall:

    (i) Provide a schedule of routine treatment team meetings where the plan of treatment is discussed;

    (ii) Establish a process for the authorized individuals to participate in treatment team meetings;

    (iii) If the treatment team meeting is being held outside the regular schedule, inform the authorized individuals as soon as the meeting is scheduled; and

    (iv) If the treatment team meeting is being held due to an emergency, inform the authorized individuals of the outcome of the meeting as soon as practicable.

  (3) The individual may withdraw the consent given under paragraph (1) of this subsection at any time orally or in writing.

  (4) A treating provider may withhold information on an individual plan of treatment from a family member or other authorized individual if:

    (i) In the treating provider's clinical judgment, the consent given under paragraph (1) of this subsection was provided through coercive means;

    (ii) The treating provider believes it is in the best clinical interest of the individual; or

    (iii) The individual requests that a specific piece of the plan of treatment be withheld.

(g)

  (1) If an individual admitted to a facility or any family member or other individual authorized by the individual to participate in the review and reassessment of the plan of treatment for the individual under subsection (f) of this section believes that the plan of treatment is not meeting the needs of the individual, the individual, family member, or other authorized individual has the right to request that the facility review and reassess the plan of treatment.

  (2) On receipt of a request under paragraph (1) of this subsection, the facility staff who work directly with and provide treatment to the individual shall:

    (i) Conduct a review and reassessment of the plan of treatment;

    (ii) Communicate the results of the review and reassessment of the plan of treatment to the patient and individual who requested the review and reassessment, including an explanation of how all issues raised in the request were considered; and

    (iii) Include the request for the review and reassessment of the plan of treatment and the outcome of the review and assessment, including the explanation of the outcome, in the medical records of the individual.

  (3) If a State facility does not make any changes to the plan of treatment for the individual, the State facility shall provide referral information for the Resident Grievance System established under COMAR 10.21.14.

(h) An individual admitted to a State facility or another individual authorized by the admitted individual may request a reconsideration of the review and reassessment completed under subsection (g) of this section by filing a grievance with the Resident Grievance System under COMAR 10.21.14.

(i)

  (1) An individual admitted to a State facility or another individual authorized by the admitted individual may appeal the reconsideration of the review and reassessment completed under subsection (h) of this section by filing a request with the Department's Healthcare System's Chief Medical Officer.

  (2) The Department shall adopt regulations to establish a process for the appeal of the reconsideration of the review and reassessment under paragraph (1) of this subsection.

(j) If an individual is admitted to a State facility and the State facility is unable to provide the treatment necessary to address the rehabilitation needs of an individual under a plan of treatment for the individual, the State facility shall:

  (1) Make arrangements for the individual to receive necessary treatment from another facility or other health care provider outside the State facility; and

  (2) Ensure that treatment for the individual is coordinated between the State facility and the other facility or health care provider.

#### Section 10-707

An individual in a facility has the right to refuse to participate as a subject in physically intrusive research conducted at the facility.

#### Section 10-708

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Lay advisor" means an individual at a facility, who is knowledgeable about mental health practice and who assists individuals with rights complaints.

  (3) "Medication" means psychiatric medication prescribed for the treatment of a mental disorder.

  (4) "Panel" means a clinical review panel that determines, under the provisions of this section, whether to approve that medication be administered to an individual who objects to the medication.

(b) Medication may not be administered to an individual who refuses the medication, except:

  (1) In an emergency, on the order of a physician where the individual presents a danger to the life or safety of the individual or others; or

  (2) In a nonemergency, when the individual is hospitalized involuntarily or committed for treatment by order of a court and the medication is approved by a panel under the provisions of this section.

(c)

  (1) A panel shall consist of the following individuals appointed by the chief executive officer of the facility or the chief executive officer's designee, one of whom shall be appointed chairperson:

    (i) The clinical director of the psychiatric unit, if the clinical director is a physician, or a physician designated by the clinical director;

    (ii) A psychiatrist; and

    (iii) A mental health professional, other than a physician.

  (2) If a member of the clinical review panel also is directly responsible for implementing the individualized treatment plan for the individual under review, the chief executive officer of the facility or the chief executive officer's designee shall designate another panel member for that specific review.

(d)

  (1) The chief executive officer of the facility or the chief executive officer's designee shall give the individual and the lay advisor written notice at least 24 hours prior to convening a panel.

  (2) Except in an emergency under subsection (b)(1) of this section, medication or medications being refused may not be administered to an individual prior to the decision of the panel.

(e)

  (1) The notice under subsection (d)(1) of this section shall include the following information:

    (i) The date, time, and location that the panel will convene;

    (ii) The purpose of the panel; and

    (iii) A complete description of the rights of an individual under paragraph (2) of this subsection.

  (2) At a panel, an individual has the following rights:

    (i) To attend the meeting of the panel, excluding the discussion conducted to arrive at a decision;

    (ii) To present information, including witnesses;

    (iii) To ask questions of any person presenting information to the panel;

    (iv) To request assistance from a lay advisor; and

    (v) To be informed of:

      (1) The name, address, and telephone number of the lay advisor;

      (2) The individual's diagnosis; and

      (3) An explanation of the clinical need for the medication or medications, including potential side effects, and material risks and benefits of taking or refusing the medication.

  (3) The chairperson of the panel may:

    (i) Postpone or continue the panel for good cause, for a reasonable time; and

    (ii) Take appropriate measures necessary to conduct the panel in an orderly manner.

(f) Prior to determining whether to approve the administration of medication, the panel shall:

  (1) Review the individual's clinical record, as appropriate;

  (2) Assist the individual and the treating physician to arrive at a mutually agreeable treatment plan; and

  (3) Meet for the purpose of receiving information and clinically assessing the individual's need for medication by:

    (i) Consulting with the individual regarding the reason or reasons for refusing the medication or medications and the individual's willingness to accept alternative treatment, including other medication;

    (ii) Consulting with facility personnel who are responsible for initiating and implementing the individual's treatment plan, including discussion of the current treatment plan and alternative modes of treatment, including medications that were considered;

    (iii) Receiving information presented by the individual and other persons participating in the panel;

    (iv) Providing the individual with an opportunity to ask questions of anyone presenting information to the panel; and

    (v) Reviewing the potential consequences of requiring the administration of medication and of withholding the medication from the individual.

(g) The panel may approve the administration of medication or medications and may recommend and approve alternative medications if the panel determines that:

  (1) The medication is prescribed by a psychiatrist for the purpose of treating the individual's mental disorder;

  (2) The administration of medication represents a reasonable exercise of professional judgment; and

  (3) Without the medication, the individual is at substantial risk of continued hospitalization because of:

    (i) Remaining seriously mentally ill with no significant relief of the mental illness symptoms that:

      (1) Cause the individual to be a danger to the individual or others while in the hospital;

      (2) Resulted in the individual being committed to a hospital under this title or Title 3 of the Criminal Procedure Article; or

      (3) Would cause the individual to be a danger to the individual or others if released from the hospital;

    (ii) Remaining seriously mentally ill for a significantly longer period of time with the mental illness symptoms that:

      (1) Cause the individual to be a danger to the individual or to others while in the hospital;

      (2) Resulted in the individual being committed to a hospital under this title or Title 3 of the Criminal Procedure Article; or

      (3) Would cause the individual to be a danger to the individual or others if released from the hospital; or

    (iii) Relapsing into a condition in which the individual is unable to provide for the individual's essential human needs of health or safety.

(h)

  (1) A panel shall base its decision on its clinical assessment of the information contained in the individual's record and information presented to the panel.

  (2) A panel may meet privately to reach a decision.

  (3) A panel may not approve the administration of medication where alternative treatments are available and are acceptable to both the individual and the facility personnel who are directly responsible for implementing the individual's treatment plan.

(i)

  (1) A panel shall document its consideration of the issues and the basis for its decision on the administration of medication or medications.

  (2) A panel shall provide a written decision on the administration of medication or medications, and the decision shall be provided to the individual, the lay advisor, and the individual's treatment team for inclusion in the individual's medical record.

  (3) If a panel approves the administration of medication, the decision shall specify:

    (i) The medication or medications approved and the dosage and frequency range;

    (ii) The duration of the approval, not to exceed the maximum time provided under subsection (n) of this section; and

    (iii) The reason that alternative treatments, including the medication, if any, were rejected by the panel.

  (4) If a panel approves the administration of medication, the decision shall contain:

    (i) Notice of the right to request a hearing under subsection (l) of this section;

    (ii) The right to request representation or assistance of a lawyer or other advocate of the individual's choice; and

    (iii) The name, address, and telephone number of the designated State protection and advocacy agency and the Lawyer Referral Service.

(j) A panel shall convene within 9 days after an individual's refusal of medication for a period of at least 72 hours if:

  (1) The individual was committed to a hospital under Title 3 of the Criminal Procedure Article because of a mental disorder; and

  (2) The treatment plan developed under Sec. 10-706 of this subtitle indicates that there is a substantial likelihood that, without immediate treatment, the individual will remain a danger to self or the person or property of another.

(k) If a panel approves the administration of medication, the lay advisor promptly shall:

  (1) Inform the individual of the individual's right to appeal the decision under subsection (l) of this section;

  (2) Ensure that the individual has access to a telephone as provided under Sec. 10-702(b) of this subtitle;

  (3) If the individual requests a hearing, notify the chief executive officer of the facility or the chief executive officer's designee pursuant to subsection (l)(1) of this section and give the individual written notice of the date, time, and location of the hearing; and

  (4) Advise the individual of the provision for renewal of an approval under subsection (n) of this section.

(l)

  (1) An individual may request an administrative hearing to appeal the panel's decision by filing a request for hearing with the chief executive officer of the facility or the chief executive officer's designee within 48 hours of receipt of the decision of the panel.

  (2) Within 24 hours of receipt of a request for hearing, the chief executive officer of the facility or the chief executive officer's designee shall forward the request to the Office of Administrative Hearings.

  (3) An initial panel decision authorizing the administration of medication shall be stayed for 48 hours. If a request for hearing is filed, the stay shall remain in effect until the issuance of the administrative decision.

  (4) The Office of Administrative Hearings shall conduct a hearing and issue a decision within 7 calendar days of the decision by the panel.

  (5) The administrative hearing may be postponed by agreement of the parties or for good cause shown.

  (6) The administrative law judge shall conduct a de novo hearing to determine if the standards and procedures in this section are met.

  (7) At the hearing, the individual representing the facility:

    (i) May introduce the decision of the panel as evidence; and

    (ii) Shall prove, by a preponderance of the evidence, that the standards and procedures of this section have been met.

  (8) The administrative law judge shall state on the record the findings of fact and conclusions of law.

  (9) The determination of the administrative law judge is a final decision for the purpose of judicial review of a final decision under the Administrative Procedure Act.

(m)

  (1) Within 14 calendar days from the decision of the administrative law judge, the individual or the facility may appeal the decision and the appeal shall be to the circuit court on the record from the hearing conducted by the Office of Administrative Hearings.

  (2) The scope of review shall be as a contested case under the Administrative Procedure Act.

  (3)

    (i) Review shall be on the audiophonic tape without the necessity of transcription of the tape, unless either party to the appeal requests transcription of the tape.

    (ii) A request for transcription of the tape shall be made at the time the appeal is filed.

    (iii) The Office of Administrative Hearings shall prepare the transcription prior to the appeal hearing, and the party requesting the transcription shall bear the cost of transcription.

  (4) The circuit court shall hear and issue a decision on an appeal within 7 calendar days from the date the appeal was filed.

(n)

  (1) Treatment pursuant to this section may not be approved for longer than 90 days.

  (2)

    (i) Prior to expiration of an approval period and if the individual continues to refuse medication, a panel may be convened to decide whether renewal is warranted.

    (ii) Notwithstanding the provisions of paragraph (1) of this subsection, if a clinical review panel approves the renewal of the administration of medication or medications, the administration of medication or medications need not be interrupted if the individual appeals the renewal of approval.

(o) When medication is ordered pursuant to the approval of a panel under this section and at a minimum of every 15 days, the treating physician shall document any known benefits and side effects to the individual.

(p)

  (1) The Administration shall develop and conduct training on the requirements of this section to ensure compliance at all State facilities.

  (2) The training is mandatory for all clinical directors and all individuals who are eligible to serve on a panel.

#### Section 10-709

(a) In accordance with Sec. 10-809 of this title, a facility shall prepare a written aftercare plan for an individual who has been accepted as a resident in the facility before that individual is released from the facility.

(b) The aftercare plan prepared under this section shall be offered to individuals who have been accepted as residents in a facility who are scheduled for release from a facility under this title.

(c) The Secretary shall adopt regulations governing the planning and provisions of aftercare plans including:

  (1) Procedures to obtain the consent of the individual; or

  (2) Procedures to assist an individual who is unable to participate fully in aftercare planning.

#### Section 10-710

(a) Each minor who is being cared for or treated in a residential, State facility shall be placed in a unit for minors and may not be placed in a unit where adults are placed, unless the individual plan of treatment for the minor provides otherwise.

(b) A person, on behalf of the minor, may file a petition in the circuit court for the county where the facility is located, to compel compliance with this section.

#### Section 10-711

On request, the administrative head of each facility shall give to the Director or a representative of the Director:

(1) Any information that the administrative head has about an individual in the facility;

(2) Access to the individual; and

(3) Access to any part of the facility.

#### Section 10-712

(a)

  (1) Each facility shall keep complete records for each individual who is admitted to the facility under this title.

  (2) The records shall contain all of the information that is required by this title or the Administration.

(b) A facility shall keep the records in a separate and secure area at the facility.

#### Section 10-713

(a)

  (1) In this section, "program or facility" means an inpatient or residential treatment setting, residential crisis service, group home, or residential rehabilitation program.

  (2) Upon notification of the death of an individual in a State funded or operated program or facility, the administrative head of the program or facility shall report the death:

    (i) Immediately to the sheriff, police, or chief law enforcement official in the jurisdiction in which the death occurred;

    (ii) Immediately to the Secretary; and

    (iii) By the close of business of the next working day to:

      (1) The Director;

      (2) The health officer in the jurisdiction where the death occurred; and

      (3) The designated State protection and advocacy system.

  (3) An initial report:

    (i) May be:

      (1) Oral if followed by a written report within 5 working days from the date of the death; or

      (2) Written;

    (ii) Shall contain the following relevant information:

      (1) The name, age, and sex of the deceased;

      (2) The time of discovery of the death;

      (3) The deceased's place of residence at the time of death;

      (4) The location of the body at the time of discovery;

      (5) The place where the body was found;

      (6) The name of the person who took custody of the body;

      (7) The name of the person evaluating the death, if known;

      (8) Whether or not an autopsy is being performed, if known; and

      (9) The name, address, and telephone number of the next of kin or legal guardian, if known; and

    (iii) Shall contain any other information the administrative head of the facility determines should be provided to the medical examiner and the persons listed in paragraph (2) of this subsection on the deaths occurring:

      (1) By violence;

      (2) By suicide;

      (3) By casualty;

      (4) Suddenly, if the deceased was in apparent good health; or

      (5) In any suspicious or unusual manner.

  (4) The written report shall be available for the Director, the health officer in the jurisdiction where the death occurred, and the designated State protection and advocacy system within 5 working days from the date of the death.

  (5) If the death occurred in a program or facility that operates more than one treatment program and where the deceased individual attended more than one treatment program, the facility is required to make only one report.

  (6) The sheriff, police, or chief law enforcement officer shall inform the medical examiner in accordance with Sec. 5-309(b) of this article and the medical examiner, if necessary, shall conduct an investigation in accordance with the provisions of that section.

(b) If the death occurred in a nonresidential psychiatric rehabilitation program, the administrative head of the program shall report the death to the Director by the close of business of the next working day.

(c)

  (1) The Director shall compile annually a status report for the Secretary on patient deaths reported under this subtitle.

  (2) At a minimum, the status report shall note:

    (i) The number of deaths;

    (ii) The location of each death;

    (iii) The cause of each death, if known; and

    (iv) Other data the Secretary determines to be relevant to the status report.

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Md. Code Ann., Health-Gen. (as displayed at mgaleg.maryland.gov, October 16, 2026)