Dept. of Health v. Boulden

Maryland Department of Health v. Jeffrey Boulden, et. al., No. 35, September Term, 2025. Opinion by Biran, J. CRIMINAL PROCEDURE – DEFENDANTS FOUND INCOMPETENT TO STAND TRIAL AND DANGEROUS – STATUTORY SANCTIONS – When a court finds a criminal defendant to be incompetent to stand trial and dangerous (“IST”), the court must order the defendant committed to a designated health care facility for treatment to restore the defendant to competency. By statute, the Maryland Department of Health (the “Department”) is required to admit an IST defendant to a designated facility as soon as possible, but not later than 10 business days after the Department receives the court commitment order. Under Md. Code Ann., Crim. Proc. (“CP”) § 3-106(c)(4) (2025 Repl. Vol.), if the Department fails to meet the 10-day deadline, a court “may impose any sanction reasonably designed to compel compliance[.]” The Supreme Court of Maryland held that a court is authorized under CP § 3-106(c)(4) to impose monetary sanctions that are reasonably designed to compel the Department to admit the defendant before the court to a designated facility as soon as possible after expiration of the 10-day deadline. If there is a waiting list for admission to a designated facility, a court may sanction the Department for each day that it does not manage the waiting list so as to admit the defendant before the court as soon as possible beginning on the eleventh business day following receipt of the defendant’s commitment order. The Court held that the sanctions orders issued in Respondents’ cases were reasonably designed to compel the Department to admit Respondents to designated facilities as soon as possible. CRIMINAL PROCEDURE – DEFENDANTS FOUND INCOMPETENT TO STAND TRIAL AND DANGEROUS – STATUTORY SANCTIONS – The Supreme Court of Maryland held that a court does not lose its authority to impose sanctions under CP § 3-106(c)(4) after the Department belatedly admits a defendant to a designated facility. APPELLATE PRACTICE – WAIVER – MARYLAND RULE 8-131 – The Supreme Court of Maryland held that the Department waived its argument concerning separation of powers after it raised the argument at one of the circuit court hearings and abandoned it on appeal. However, in light of the Court’s decision to invite supplemental briefing concerning separation of powers and the possibility that the Department may raise the same argument in future cases, the Court exercised its discretion under Maryland Rule 8-131(b) to decide the issue. MARYLAND CONSTITUTION – SEPARATION OF POWERS – COURTS’ IMPOSITION OF SANCTIONS UNDER CP § 3-106(c)(4) – The Supreme Court of Maryland held that the General Assembly did not violate the separation of powers by providing courts with the discretion to impose sanctions under CP § 3-106(c)(4). In awarding sanctions to enforce compliance with CP § 3-106, a court engages in a quintessential judicial function that is specifically authorized by law. Circuit Court for Kent County Case Nos. C-14-CR-21-000044, C-14-CR-23-000050, C-14-CR-23-000146 Circuit Court for Baltimore County Case Nos. C-03-CR-24-000015, C-03-CR-24-000251, C-03-CR-23-002969, C-03-CR-23-003449, C-03-CR-23-003775 Argued: January 6, 2026 IN THE SUPREME COURT OF MARYLAND No. 35 September Term, 2025 MARYLAND DEPARTMENT OF HEALTH v. JEFFREY BOULDEN, ET AL. Watts Booth Biran Gould Eaves Killough Hotten, Michele D., (Senior Justice, Specially Assigned), JJ. Opinion by Biran, J. Booth, Gould, and Killough, JJ., dissent. Pursuant to the Maryland Uniform Electronic Legal Materials Act (§§ 10-1601 et seq. of the State Government Article) this document is authentic. 2026.07.15 Filed: July 15, 2026 13:40:37 -04'00' Gregory Hilton, Clerk  A long-established imperative in our criminal justice system is that defendants must be competent to stand trial. The standard to determine competency in Maryland is whether the accused is able to understand the nature of the proceedings against them and to assist in their defense. The prohibition against trying an incompetent defendant stems from the defendant’s due process right to a fair trial. In Maryland, when a court finds that a defendant is not competent to stand trial and dangerous to self or others because of a mental condition (“IST”), the court must order the defendant to be committed to a health care facility administered by the Maryland Department of Health (the “Department” or “Health Department”), the Petitioner before us. After the Department receives custody of the defendant, the Department attempts to restore the defendant to competency through treatment. In 2016, a group of criminal defendants deemed IST brought a civil suit against the Department for its failure to comply with commitment orders mandating their transfers to a designated health care facility within one day. See Powell v. Maryland Dep’t of Health, 455 Md. 520, 533-34 (2017). The defendants brought both a statutory claim under Md. Code Ann., Crim. Proc. (“CP”) § 3-106 (2001, 2008 Repl. Vol., 2013 Supp.), and a constitutional claim alleging that the failure to admit them to designated facilities violated their right to due process guaranteed by Article 24 of the Maryland Declaration of Rights. See id. at 536. This Court affirmed the circuit court’s dismissal of the statutory claim. Id. at 542-48, 555. At that time, CP § 3-106 did not authorize a court to set a deadline for admission. Id. at 543. We explained that, in the absence of a statutory deadline, the reasonableness of any delay must be assessed on a case-by-case basis, considering a host of factors. See id. at 552. The General Assembly responded quickly to Powell, amending CP § 3-106 in 2018 to mandate a uniform admission timeline for all defendants deemed IST. The Department now is required to place every IST defendant in a designated facility as soon as possible, but not later than 10 business days after the Department receives the court commitment order. See CP § 3-106(c)(2)(i) (2025 Repl. Vol.). If the Department fails to meet the 10- day deadline, the court “may impose any sanction reasonably designed to compel compliance, including requiring the Health Department to reimburse a detention facility for expenses and costs incurred in retaining the defendant” beyond the deadline. Id. § 3-106(c)(4). Respondents Jeffrey Boulden, Glenn Hawkins, William Lomax, Kennard Goins, Malik Jackson, and Steven Kauffman were each found IST by a circuit court. The Department failed to comply with the 10-day deadline in admitting Respondents to designated health care facilities. Respondents then sought and obtained sanctions against the Department under CP § 3-106(c)(4). Four of the Respondents (Messrs. Boulden, Lomax, Jackson, and Kauffman) had not yet been transferred to hospitals when the circuit courts held hearings and imposed sanctions. The other two Respondents (Messrs. Hawkins and Goins) received their placements before the hearing in their cases. The court also imposed sanctions in their cases. On appeal, the Appellate Court of Maryland held that the circuit courts did not abuse their discretion in deciding to impose sanctions. However, the Appellate Court ordered a 2 remand in four of the cases for recalculation of the amount of sanctions. The Department sought further review in this Court. The Department argues before us that the circuit courts abused their discretion by imposing sanctions in all six cases. In the Department’s view, none of the sanctions orders were “reasonably designed to compel compliance” within the meaning of CP § 3-106(c)(4) because it was impossible for the Department to comply with the 10-day deadline. In support of that assertion, the Department points to the long waiting list that existed for admission to designated facilities. The Department also asserts that it must prioritize admission based on acuity of illness, and that this requirement made it impossible to admit Respondents more quickly. As to Messrs. Hawkins and Goins, the Department contends that the sanctions also were not reasonably designed to compel compliance for a second reason: because the Department admitted them to designated facilities before the court imposed sanctions, the Department asserts that there was no compliance left for the court to compel. Finally, the Department argues that, in imposing sanctions in these cases, the circuit courts violated Article 8 of Maryland’s Declaration of Rights, which requires the separation of governmental powers. We disagree with the Department on all points and affirm the judgment of the Appellate Court. 3  I Background After being charged with criminal offenses, Respondents were found IST under CP § 3-106(c)(1)(i).1 As a result, the courts presiding over their cases issued orders committing Respondents to the Department “until the court is satisfied [Respondent] is no longer incompetent to stand trial or is no longer, by reason of a mental disorder or mental retardation, a danger to self or the person or property of another.” The Department was required to admit Respondents to a “designated health care facility”2 “as soon as possible, 1 CP § 3-106(c)(1)(i) provides: If, after a hearing, the court finds that the defendant is incompetent to stand trial and, because of a mental disorder or an intellectual disability, is a danger to self or the person or property of another, the court shall order the defendant committed to the facility that the Health Department designates until the court finds that: 1. the defendant no longer is incompetent to stand trial; 2. the defendant no longer is, because of a mental disorder or an intellectual disability, a danger to self or the person or property of others; or 3. there is not a substantial likelihood that the defendant will become competent to stand trial in the foreseeable future. 2 Health care facilities designated for competency restoration include facilities owned or operated by the Department, state forensic residential centers, and hospitals and private residential facilities with which the Department contracts to house and treat IST individuals. CP § 3-106(a)(1); Md. Code Ann., Health-Gen. (“HG”) § 10-101(k) (1982, 2023 Repl. Vol., 2025 Supp.). A “designated health care facility” does not include a correctional or detention facility. CP § 3-106(a)(2). 4 but not later than 10 business days after the Health Department receive[d] the order of commitment[.]” CP § 3-106(c)(2)(i). The Department failed to timely admit Respondents to designated facilities. Respondents filed motions seeking relief for the Department’s violation of the deadline. As stated above, CP § 3-106(c)(4) provides that, if the Department fails to admit a defendant to a designated health care facility within 10 business days, “the court may impose any sanction reasonably designed to compel compliance, including requiring the Health Department to reimburse a detention facility for expenses and costs incurred in retaining the defendant” beyond the deadline. The circuit courts held hearings with respect to the Department’s failure to admit Respondents, and imposed sanctions in each case. A. Mr. Boulden (Kent County Circuit Court) Mr. Boulden was charged with various crimes in three cases filed in the Circuit Court for Kent County. On February 2, 2024, the circuit court issued commitment orders in Mr. Boulden’s cases. After the Department failed to admit Mr. Boulden to a designated health care facility within 10 business days, Mr. Boulden’s attorney moved for an order to show cause. A hearing on Mr. Boulden’s motion went forward on April 5, 2024, before the Honorable Harris P. Murphy. As of the date of the hearing, the Department had not admitted Mr. Boulden to a designated health care facility. The Department called as its only witness Bryan Mroz, then the Deputy Secretary of Operations of the Department’s Healthcare System. Mr. Mroz testified that there were 1,056 beds across designated health care facilities within the state, with the average length of stay being a little over two years. According to Mr. Mroz, the current daily cost to 5 hospitalize an IST individual was approximately $600 to $1,000. All beds were occupied at the time of the April 5, 2024 hearing, and 202 individuals were on the Department’s waiting list, including Mr. Boulden. Mr. Mroz thought there were also five hospital warrants open at the time.3 Regarding how defendants move up or down on the waiting list, Mr. Mroz explained: Well, it takes into account when we get the order. So if things were neutral, you know, it would just go through as they come in. But we do look at things such as acuity, which is a big factor which moves people up the list. We also have to take into account a hospital warrant, which is somebody in the community who made [sic] need to come back immediately, and those have to be incorporated into the list. We also look at the type of charges. So that’s also incorporated into the list. And then also how long somebody has just generally been on the list, because we don’t want somebody that -- being at the bottom. We have to take that into account also as we move through. The waiting list had grown over the past several years, Mr. Mroz testified, due to several factors: (1) incoming court commitment orders in recent years had begun to vastly outnumber the beds available statewide; (2) defendants’ lack of necessary documents and inadequate community placement options created a sizeable backlog to discharge; and (3) hospital accreditation standards prevented the Department from increasing the number of beds quickly to meet the growing demand. Lack of Capacity Mr. Mroz testified that in 2017, in response to substantial delays in admission, the Department created a centralized admission process, which enabled the Department to 3 A hospital warrant is a “legal document issued by a court that … authorizes any law enforcement officer in the State to apprehend a person who is alleged to have violated an order for conditional release and transport the person to a facility designated by the Health Department[.]” CP § 3-101(e)(1). 6 timely admit IST defendants.4 However, “a spike in [commitment] orders” after the COVID-19 pandemic outpaced the Department’s efforts to eliminate admission inefficiencies. According to Mr. Mroz, the total number of court commitment orders in 2019 was approximately 750. During the COVID-19 pandemic, that number decreased to around 600 in 2020; it was back up to approximately 700 in 2021. In 2022, the Department received approximately 860 court commitment orders; the number increased to 1,100 in 2023. Obstacles to Discharge Although there were “right around 100” individuals clinically ready to be discharged at the time of the hearing, Mr. Mroz said that the Department could not timely discharge them to free up their beds for new admissions from the waiting list. Some of the individuals ready for discharge lacked appropriate documents such as a driver’s license, birth certificate, or social security card, which prevented the Department from securing private community placements for them after discharge. To reduce the discharge backlog, the Department created “a linkage to MDOT,” and hired outside lawyers to assist individuals with procuring the necessary documents. Mr. Mroz could not provide data on 4 Before 2017, there was no centralized database to monitor bed availability across designated health care facilities. See State v. Crawford, 239 Md. App. 84, 107 (2018). Mr. Mroz explained that “every court order went to all the hospitals,” and the Department had to “negotiate around to see if there was a bed[,]” even if an order mandated placement at a particular facility. Under that system, “court orders often were ranked based on which judge ‘yelled the loudest.’” Id. 7 how many out of the approximately 100 individuals ready for discharge were held up because they lacked the necessary documents.5 In addition to the lack of documentation, Mr. Mroz explained, many community providers, such as residential rehabilitation programs, nursing homes, and assisted living facilities lacked sufficient resources to operate at full capacity. Without private community placements for continued care and treatment, the Department could not discharge individuals even if they were clinically ready for discharge. According to Mr. Mroz, the Department was “working with [community providers] every day … to build up the capacity … [and] funding.” The Department also launched pilot programs to transfer individuals from the five adult psychiatric hospitals to the Department’s long-term care facilities, and to allow community providers to come onsite at state hospitals to get a head start on the discharge process. Acuity and Other Considerations Affecting Waiting List Position Mr. Mroz testified that the Department could not simply move individuals up the waiting list to comply with the statutory time limit because doing so would contravene clinical judgments about the relative acuity of the people waiting for placement. Under the 5 According to data that the Department has made publicly available, as of May 2023, five of the 153 individuals (3.27%) ready to be discharged lacked documentation. See Maryland Dep’t of Health, Comm’n on Behavioral Health Care Treatment and Access, Criminal Justice-Involved Behavioral Health Workgroup Presentation, at 10 (Dec. 8, 2023), available at https://perma.cc/RSD8-BPL3. As of September 12, 2024, two of the 119 individuals (1.68%) waiting to be discharged were in that category. See Maryland Dep’t of Health, Criminal Justice-Involved Behavioral Health Workgroup & Criminal Justice Forensic Subcomm., Presentation of Overview of MDH Psychiatric Facilities and Current Trends, at 21 (October 1, 2024) (“Oct. 1, 2024 Presentation”), available at https://perma.cc/TA46-AJJ3. 8 Department’s acuity-focused approach, “the more sick they are[,] the higher they are on the waiting list[.]” Mr. Mroz elaborated that the determination of a defendant’s acuity for purposes of positioning on the waiting list is a “clinical decision[] made in conjunction with the detention centers and the clinicians within” the Department, based on a host of factors such as suicidal or homicidal ideation, physical and somatic conditions, whether the individual is in compliance with medication, and the detention center’s ability to handle that particular individual’s acuity. According to Mr. Mroz, because state and federal accreditations define the standards of care at designated health care facilities, the facilities risked losing the accreditations, licensure, and funding necessary to remain in operation if the Department adjusted the waiting list order without regard to acuity. Mr. Mroz testified that the Department also gives priority to defendants based on the “type of charges” that are pending against them.6 In addition, Mr. Mroz explained, the Department prioritizes those individuals who are the subject of hospital warrants.7 6 At the Baltimore County hearing discussed below, Mr. Mroz elaborated that “we look at the timing of their … Court case. We look at the charges against them and if they would time out.” Under CP § 3-107, the court must dismiss the charge against a defendant found incompetent to stand trial after expiration of a specified period of time. For a defendant charged with a felony or a crime of violence (as defined in section 14-101 of the Criminal Law Article), that period is the lesser of five years or the maximum sentence for the most serious offense charged. CP § 3-107(a)(1). For a defendant charged with any other offense, the period is the lesser of three years or the maximum sentence for the most serious offense charged. Id. § 3-107(a)(2). 7 At the Baltimore County hearing discussed below, Mr. Mroz testified that individuals apprehended under hospital warrants receive top priority: “Hospital warrants come back immediately…. [A]s fast as I can get a bed, they would get that bed.” 9  Mr. Boulden’s Tentative Admission Date At the time of the hearing on April 5, 2024, according to Mr. Mroz, Mr. Boulden had a tentative admission date of April 8, 2024, to Eastern Shore Hospital Center (“Eastern Shore”). Mr. Mroz testified that the clinicians did not mention that Mr. Boulden’s acuity “was severe or would cause him to move up the waitlist.” Mr. Mroz was unable to provide Mr. Boulden’s exact number on the waiting list, but explained that if there were others ahead of Mr. Boulden on the list, they might be assigned to beds at other facilities. Mr. Mroz also was unable to say whether or what operational limitations were currently preventing Eastern Shore from discharging any individuals who were ready for discharge. Mr. Mroz testified that the tentative admission date of April 8 meant that the Department expected a bed to become available that day at Eastern Shore. However, he explained that Mr. Boulden’s admission could be delayed beyond April 8 if there was an issue with the discharge of the patient leaving that bed, or if someone apprehended under a hospital warrant needed to be placed at Eastern Shore. In addition, if there was “a sudden decompensation of somebody who’s highly acute, we may have to put that person in that bed.” Difficulty in Expanding Capacity Quickly Responding to questions from the Department’s attorney, Mr. Mroz testified that the Department has been attempting to add more beds to the system. He explained that the Department has added beds at Spring Grove Hospital Center and Springfield Hospital 10 Center,8 and that it has plans underway to expand maximum security beds at Clifton T. Perkins Hospital Center (“Perkins”). Further, the Department was developing a “master services plan” to “address all those needs in the next … 10 to 20 years as we move forward.” Presently, however, the Department did not have enough beds to keep pace with demand. Mr. Mroz also explained that accreditation requirements prevent the Department from taking stopgap measures such as putting beds in hallways or renting space in hotels. Effect of a Sanction When asked whether the imposition of sanctions would induce the Department to comply with the order to commit Mr. Boulden, Mr. Mroz replied, “[N]o. I mean, we are spending millions of dollars trying to resolve this waitlist. I cannot imagine any fine – there’s nothing that would help us move faster. We’re moving as fast as we can.” He emphasized that the Department had not willfully violated Mr. Boulden’s commitment order: “We’re very much aware of it. We’re working as hard as we can to comply and get them in as quickly as we can. In his case we’re watching it every day …, every chance we can get to move through that waitlist we take.” When asked if there is “an ability, an 8 In its February 7, 2018, letter opposing the passage of S.B. 233, the bill that added the 10-day deadline and sanctions mechanism to CP § 3-106, the Department stated that the total number of beds across its five psychiatric facilities was 977. At a hearing in another case in February 2023, Mr. Mroz testified that the total number of beds was 1,056. The Department provided the same figure of 1,056 beds at the April 5, 2024, hearing regarding the placement of Mr. Boulden, the two hearings regarding the five other Respondents on May 8, 2024 and July 9, 2024, and in its opening brief filed in this Court on November 3, 2025. The Department did not mention any new beds having come online at oral argument in this Court on January 6, 2026. Thus, it appears that, since February 2018, the Department has added a total of 79 beds, representing a total increase in capacity of 8.09 percent with zero beds added for at least two years and 11 months prior to the oral argument in this case. 11 opportunity, to comply with the Court’s order[,]” Mr. Mroz replied: “I have no ability at this point. With a 202 [person] waitlist we are getting to the most acute and the most needed patients first in the best way we can.” The Court’s Ruling Judge Murphy did not find a willful violation on the part of the Department. Nevertheless, he decided to impose a sanction. Judge Murphy explained that to find a violation of CP § 3-106(c)(2), the “Court only needs to find that the Department failed to admit an individual deemed IST and dangerous into a designated facility within the statutory 10-day period.” Thus, Judge Murphy observed, “it is sort of like a strict liability standard in that context, and it has clearly been established by the record and the testimony that the order was issued and that the Department has failed to admit Mr. Boulden within the 10 days.” He continued: So the Court believes that it is appropriate to apply, or impose sanctions rather, under [CP § 3-106(c)(4)]. The testimony that has been offered today indicates that it costs approximately $600 to $1,000 a day to keep an individual in the hospital.… The Court, therefore, … in an effort to comply with the requirement imposed by that section, that the Court may impose any sanction that is reasonably designed to compel compliance, the Court is going to impose a sanction of $2,000 per day starting today. The purpose of that sanction being to double the cost to the Department through their failure to comply with the statute, thereby hopefully incentivizing them to comply with the statute. (Paragraph break omitted). The Department admitted Mr. Boulden to Eastern Shore on April 11, 2024, six days after the hearing. At $2,000 per day, the sanction imposed on the Department in Mr. Boulden’s case presumably amounted to $12,000. 12  B. Messrs. Hawkins, Lomax, Goins, Jackson, and Kauffman (Baltimore County Circuit Court) Messrs. Hawkins, Lomax, Goins, Jackson, and Kauffman were charged in criminal cases filed in the Circuit Court for Baltimore County. The court subsequently found these Respondents to be IST and issued commitment orders. After the Respondents sought relief for the Department’s failure to timely admit them to designated facilities, the Honorable Nancy M. Purpura held a joint hearing on their motions on May 8, 2024. By that date, the Department had admitted Messrs. Hawkins and Goins. Mr. Hawkins’s commitment order was issued on January 26, 2024; he was admitted on April 3, 2024. Mr. Goins’s commitment order was issued on November 3, 2023; he was admitted on May 6, 2024. As of the hearing on May 8, 2024, the Department had not yet transferred the other three Baltimore County Respondents. The court issued the commitment orders with respect to Messrs. Jackson, Kauffman, and Lomax on November 6, 2023, December 11, 2023, and March 13, 2024, respectively. Mr. Mroz’s Testimony The Department again called Mr. Mroz as its only witness.9 Mr. Mroz’s testimony at the Baltimore County hearing was largely consistent with the testimony he gave at the hearing in Mr. Boulden’s case.10 He testified about the emphasis the Department places on 9 Respondents called two employees of the Baltimore County Department of Corrections as witnesses at the hearing. 10 The transcript of the Baltimore County hearing quotes Mr. Mroz as testifying that, as of the morning of the hearing, the waiting list contained 202 individuals, “with 800 hospital warrants.” We assume that “800” is a typographical error. The transcript of the hearing in Mr. Boulden’s case quotes Mr. Mroz as stating that he believed there were five 13 acuity in determining a defendant’s position on the waiting list, which he said “really impacts the list more than anything else because we’re a hospital[.]” Mr. Mroz also testified about the systemic difficulties the Department confronted in complying with the statutory deadline. He said that he “[could not] imagine” that any monetary sanctions would compel compliance when the Department was already “trying to do everything [it] can to get in compliance” by “spending huge amounts” and committing “thousands and thousands of man hours working on this.” He also proffered that he could not “imagine a fine that would … overrule [the Department’s] clinical decision.” Mr. Mroz testified that the five Respondents were not admitted within 10 business days of their commitment orders because he “did not have a bed available for them.” However, when asked about the specific circumstances preventing the Department from admitting Messrs. Jackson, Lomax, and Kauffman sooner, Mr. Mroz provided little information. He testified that neither Mr. Lomax nor Mr. Kauffman presented high acuity that would move them up the waiting list. The Department had no tentative admission dates for either of those Respondents, and Mr. Mroz did not explain why that was the case. At that point, Mr. Kauffman had been waiting for admission to a designated facility for more than 130 days beyond the statutory deadline. Mr. Mroz testified that Mr. Jackson’s tentative admission date was the next day, May 9, 2024. Although Mr. Jackson had presented an indicator of acute illness at the hospital warrants open as of the preceding evening, April 4, 2024. We also note that, according to a publicly available MDH document, “[a]s of September 24, 2024, the MDH Court-Ordered Hospital Waitlist has 195 individuals with an additional two hospital warrants.” Oct. 1, 2024 Presentation, at 17 (emphasis added). 14 Baltimore County Detention Center, Mr. Mroz did not say that this circumstance had any effect on Mr. Jackson’s position on the waiting list. Rather, Mr. Mroz explained that, despite the indication of acuity, a clinician at the detention center opined that Mr. Jackson could be “safely maintained” there. When Judge Purpura asked what “safely maintained” meant, Mr. Mroz answered that he did not “have that definition exactly with [him]” and that he did not want to make any assumptions about what the clinician meant in using that term. Nor was Mr. Mroz able to identify the clinician at the detention center who said that Mr. Jackson could be safely maintained. As of the date of the hearing, Mr. Jackson had been waiting for transfer to a designated health care facility for almost 170 days beyond the statutory deadline. The Court’s Ruling With respect to Mr. Hawkins and Mr. Goins, the Department argued that no monetary sanctions would reasonably compel compliance because the Department had “already complied in those cases” by transferring those Respondents prior to the hearing. Judge Purpura disagreed, reasoning that the Department did not actually comply with the 10-day time limit, even if the Department had admitted Messrs. Hawkins and Goins before the hearing. She explained that the Appellate Court’s decision in Maryland Department of Health v. Myers, 260 Md. App. 565 (2024), requires only two factual findings before the imposition of sanctions: first, that the individual was deemed IST by the court, and second, that the Department failed to place the IST individual within 10 business days of receiving the court commitment order. Because both of those circumstances were the case with respect to Messrs. Hawkins and Goins, Judge Purpura rejected the Department’s argument 15 that their transfer before the hearing meant that she no longer had authority to sanction the Department for its noncompliance. Judge Purpura then discussed the course of events since the General Assembly amended CP § 3-106 in 2018. First, she noted that the “statute was revised in 2018 as a result of the very problems that we’re attempting to address today.” After quoting the preamble to Senate Bill 233 to ascertain the General Assembly’s purpose in amending the statute – i.e., to prevent the continued unlawful housing of IST defendants in detention centers – Judge Purpura concluded from the evidence introduced at the hearing that “the problem is ongoing.” Judge Purpura continued: “So, the Legislature gave the Court the tool of a sanction to coerce compliance on the part of the Department. So, what has happened since then? Well, the problem existed for many years prior to 2018, but since 2018, the Department really has not made sufficient efforts … to address the problem.… [A]t the very earliest, the Department didn’t even start engaging in talks to deal with some of these things until 2020.” Judge Purpura commented that “the mere fact that efforts weren’t made in 2018 to start to address the problem in itself, cries out for a sanction.” Judge Purpura rejected Mr. Mroz’s testimony that monetary sanctions would not compel compliance. Without “suggesting that anybody is … not being truthful in terms of their belief,” Judge Purpura stated that she did not credit the testimony “for a number of reasons.” First, Judge Purpura was of the view that the Department previously had little incentive to address its chronic delay in placing IST individuals at designated facilities. She recounted that prior to 2018, there was no statutory time limit within which the 16 Department had to secure bed placements for IST individuals. Eventually, “the Legislature came to the conclusion that it was necessary to give [the] Court the authority to impose these sanctions.” After the General Assembly enacted the 10-day statutory limit in 2018, however, it became apparent that a civil contempt proceeding was an inappropriate vehicle for courts to sanction the Department. The Department had never actually had to pay any sanctions; any sanctions imposed through civil contempt proceedings were all reversed on appeal. In light of Myers, Judge Purpura believed that a monetary sanction was reasonably designed to compel compliance “once the Department is made to understand that they will have to pay the monetary sanction.” Judge Purpura commented earlier in the hearing that “[i]t would be … beyond the level of sanity on the part of the Department to consistently be hit with monetary sanctions and not be incentivized to do anything.” She “also believe[d] that, … as the numbers [of commitment orders] have increased, … a monetary sanction for each one of these cases is going to coerce compliance.” Judge Purpura concluded: “I believe that it is reasonably designed, designed to compel compliance. I don’t think we would need to incarcerate anyone to compel compliance” because “if a monetary sanction doesn’t do it, what will?” Judge Purpura announced that she would impose “a sanction that is based on the number of days exceeding the 10-day time limitation that the person remained in the Detention Center,” and decided that the sanction would be $1,000 per day for that period of time in all five cases. She stated that she would impose the following sanctions with respect to the five Respondents: 17  Mr. Lomax: $46,000 Mr. Hawkins: $67,000 Mr. Goins: $182,000 Mr. Johnson: $174,000 Mr. Kauffman: $139,000 On May 9, 2024, Judge Purpura entered written orders imposing sanctions on the Department in the above amounts with respect to Messrs. Lomax, Hawkins, Goins, and Johnson. The orders directed the Department to deposit those amounts “into the Registry of the Court within 15 days of the docketing of this Order pending further proceedings.”11 The Second Hearing in Mr. Kauffman’s Case With respect to Mr. Kauffman’s case, on May 10, 2024, Judge Purpura reconsidered and struck without prejudice the sanctions she had orally announced at the conclusion of the May 8 hearing. Judge Purpura took this action because Mr. Kauffman, unlike the other Baltimore County Respondents, had filed a petition for contempt rather than a motion for sanctions. Mr. Kauffman subsequently filed a motion for sanctions. The parties filed a joint motion requesting that the court incorporate all testimony and arguments presented at the previous hearing, forego a second hearing, and reinstate the sanctions previously imposed. 11 Counsel for four of the Respondents asked Judge Purpura, “who does this money get paid to?” Judge Purpura replied that she was not ordering reimbursement of the Baltimore County Detention Center. Counsel then requested that the court “tailor the judgment to be to Baltimore County … so that it can be used for mental health services here for our people in Baltimore County[.]” Judge Purpura asked the parties to provide additional papers concerning to whom the funds should be directed. At the second hearing in Mr. Kauffman’s case discussed below, Judge Purpura stated that “there was an agreement between [the Department’s counsel], and the Defense and the Court that the money would go to the Baltimore County Department of Health.” 18 Judge Purpura denied the joint motion, explaining that “[a]ny efforts made by the Department to comply with the sta