ANNAPOLIS, Md. — The Supreme Court of Maryland has vacated sanctions imposed against the Maryland Department of Health in six cases involving criminal defendants who remained in jail beyond the state’s deadline for placement in psychiatric treatment facilities.
In an order filed Aug. 25, 2026, the state’s highest court sent the cases back to the Circuit Court for Baltimore County for reconsideration in light of a July ruling that clarified how courts may sanction the Health Department when defendants found incompetent to stand trial remain in detention too long.
The six defendants had each been found incompetent to stand trial and dangerous by the District Court in Baltimore County.
Under Maryland law, the Health Department must place such defendants in a designated health care facility as soon as possible and no later than 10 business days after receiving a commitment order.
All six remained at the Baltimore County Detention Center beyond that deadline.
Courts Imposed Sanctions After Placement Delays
The defendants sought sanctions against the Health Department after the agency failed to transfer them within the required period.
Following a consolidated hearing in August 2025, the District Court ordered the department to reimburse the Baltimore County Detention Center $141 for each day each defendant remained in custody beyond the 10-business-day deadline.
The sanctions began retroactively on the 11th business day after each commitment order and were set to continue until the defendant was admitted to a Health Department facility.
The department appealed.
In November 2025, the Circuit Court for Baltimore County issued a different set of sanctions directing the Health Department to:
- Stop requiring or relying on clinical acuity screening surveys that the court found were not authorized by statute or regulation.
- Stop conditioning admission on medical records from local detention facilities for the purpose of ranking defendants by acuity.
- Admit defendants found incompetent to stand trial and dangerous in the chronological order of their commitment orders.
The Health Department appealed those sanctions as well.
Supreme Court Says Sanctions Went Too Far
The Supreme Court held the six cases while it considered a separate case, Maryland Department of Health v. Boulden, which addressed the scope of sanctions courts may impose when the department misses the 10-day deadline.
The court issued its decision in Boulden on July 15.
In that case, the court held that judges may impose sanctions designed to compel the Health Department to place the specific defendant before the court into a treatment facility as soon as possible after the statutory deadline has passed.
But the court said sanctions must be tied to securing compliance for the individual defendant involved in the case.
Applying that reasoning to the six Baltimore County cases, the Supreme Court concluded that the circuit court’s broader directives did not comply with the Boulden decision.
The court also found that nothing in Boulden authorized a circuit court to prohibit the Health Department from considering a defendant’s clinical acuity when making placement decisions.
The justices emphasized that state law neither requires nor authorizes courts to dictate exactly how the department must prioritize acuity among multiple defendants awaiting treatment.
Cases Sent Back To Baltimore County
For each of the six cases, the Supreme Court granted the Health Department’s request for review, vacated the Baltimore County Circuit Court’s judgment and remanded the cases for reconsideration under the standard established in Boulden.
The ruling does not eliminate the Health Department’s obligation to place defendants found incompetent and dangerous within 10 business days.
Maryland law still permits judges to impose sanctions when the department misses that deadline, including requiring reimbursement to detention facilities for the additional cost of housing a defendant.
The Supreme Court’s ruling instead limits those sanctions to measures reasonably designed to compel compliance for the particular defendant before the court, rather than broader orders governing how the Health Department prioritizes other patients statewide.
Chief Justice Matthew Fader did not participate in consideration of the petitions. Justice Jonathan Biran joined the order, while Justice Steven Gould did not. Senior Justice Shirley Watts signed the court’s order
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