Judge Considers Independent Monitor to Help with Mental Health Bed Backlog
TOWSON — The defendant in the orange jumpsuit sits quietly in a courtroom beside his public defender.He’s jailed on a rape charge, and in July a judge ruled him incompetent to stand trial and ordered him committed to a state psychiatric hospital.
Under Maryland law, he must be hospitalized within 10 business days of that order.As of Friday, he had been waiting 100 days past that deadline.The Maryland Department of Health (MDH) has been under pressure for years to improve how quickly it finds psychiatric beds for committed inmates.
On Friday, a Baltimore County Circuit Court judge said he will consider a request from the public defender’s office to appoint an independent monitor to oversee how the MDH handles its long-standing backlog.
Judge Thomas Tompsett said he will weigh the request from Baltimore County District Public Defender James Dills as he determines appropriate sanctions against the MDH in this case.
𝐀 𝐃𝐞𝐟𝐞𝐧𝐝𝐚𝐧𝐭 𝐢𝐧 𝐂𝐫𝐢𝐬𝐢𝐬
Staff and doctors at the Baltimore County jail say Friday’s defendant has been suicidal at times, experiences hallucinations, hears voices, gets into fights, and doesn’t always take his medication. They say he poses a safety risk to himself and others — and needs to be in a hospital.“That is horrifying,” Tompsett said. “If that’s your loved one in that facility — to hear that they are not safe there — that’s horrifying.”But as sick as he is, MDH officials say even more acute cases are also waiting for hospitalization.“These are really sick people,” Tompsett said. “I feel like, because they’re sick and in the justice system, we don’t operate with a sense of urgency for them.”
𝐌𝐃𝐇 𝐒𝐚𝐲𝐬 𝐋𝐚𝐰 𝐈𝐬 ‘𝐔𝐧𝐭𝐞𝐧𝐚𝐛𝐥𝐞’
Assistant Attorney General Marissa Capone argued that the 10-day statutory deadline is “untenable” given the department’s limited resources.“We’re doing everything we can,” Capone said. “We’re trying to be creative and use the resources we have. We need more money, or we need that statute to be changed.”Because of the seriousness of his charge, the defendant can only be housed at the state’s maximum-security psychiatric hospital, not one of the four lower-security regional hospitals.
But there are no vacancies. The wait is long — often six to eight months.And so he waits, despite the law requiring timely transfer and despite potential monetary sanctions against the MDH.He is currently 26th on a list of 63 people waiting to enter Clifton T. Perkins Hospital Center in Jessup. He may get a bed by the end of the year.
Statewide, the waitlist for all psychiatric beds — including Perkins and the regional hospitals — is now about 200 people.“I have about three or four beds a day on average open up for the entire state,” said Amelia Tibbett, director of the Post-Acute Care Unit for the MDH’s Behavioral Health Administration, who testified Friday.
“We try to admit about 15 each week, and we don’t always hit that number. Oftentimes it’s less. It depends on how many discharges we have.”
The average patient stay at Perkins is two years; at the regional hospitals, about 18 months. Discharge is also lengthy — typically three to six months to clear court, hospital, community, and administrative requirements.
𝐌𝐃𝐇 𝐂𝐥𝐚𝐢𝐦𝐬 𝐐𝐮𝐞𝐬𝐭𝐢𝐨𝐧𝐞𝐝
Some judges and defense attorneys remain skeptical that the MDH cannot move faster.
“Our list was down to 14 people at one point, when we were really pushing sanctions,” Dills said at Friday’s hearing.
As a test, he said, the public defender’s office recently paused sanctions to see whether the list would shrink or grow.The list grew to 24.
“So when the department argues there’s nothing any of us can do to make them move quicker,” Dills said, “I don’t know that that’s true.”
Tompsett appeared increasingly frustrated.
“It’s like you’re thumbing your nose at the law and the court,” he told Tibbett.
Baltimore County judges have issued monetary sanctions against the MDH since at least early 2024. In May 2024, now-retired Judge Nancy Purpura ordered about $608,000 in fines.‘
𝐖𝐞 𝐒𝐭𝐢𝐥𝐥 𝐇𝐚𝐯𝐞 𝐎𝐧𝐥𝐲 𝟏,𝟎𝟓𝟔 𝐁𝐞𝐝𝐬
’Tibbett testified the department wants to comply but is constrained by the statewide bed shortage. Maryland has not added any new state psychiatric beds in years, even as demand has skyrocketed since COVID.Over the past five years, annual commitment orders have nearly doubled, rising from about 500–700 per year to about 1,100, Tibbett said.
“And we still have only 1,056 beds,” she said.
𝐓𝐨𝐦𝐩𝐬𝐞𝐭𝐭 𝐂𝐨𝐧𝐬𝐢𝐝𝐞𝐫𝐬 𝐈𝐧𝐝𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐭 𝐌𝐨𝐧𝐢𝐭𝐨𝐫𝐢𝐧𝐠
Tompsett is so frustrated he is considering naming an independent monitor to track the MDH’s compliance with court-ordered commitments. It’s a tactic being used in Anne Arundel County, Dills said, where Senior Circuit Court Judge Ronald Silkworth has already ordered the appointment of a monitor. The MDH is expected to appeal.
“I think it’s a novel idea,” Dills said. “At this point, I’ve argued for these sanctions so many times… I’m willing to try anything.”
Whether fines are a lawful enforcement tool is now before the Supreme Court of Maryland, which will hear arguments January 6, 2026. A decision is expected next summer.Some defense attorneys now suspect the MDH is declaring defendants competent prematurely in order to free up beds.
“My faith and confidence in the Department of Health is at an all-time low,” Dills said at a Nov. 7 competency hearing. “When they send these reports, I don’t know how much of them to believe.”
Defense attorney Michelle Kim said the MDH needs to demonstrate concrete steps it’s taking to address the waitlist.
“I want to hear, in terms of my client, ‘We’re doing A, B and C.’ I’m not going to be satisfied with that,” she said, “but at least I’d know they’re working to get my client a bed at Perkins as soon as possible.”
𝐃𝐞𝐟𝐞𝐧𝐝𝐚𝐧𝐭 𝐒𝐩𝐞𝐚𝐤𝐬
After sitting through the two-hour hearing, the stocky 23-year-old defendant asked if he could speak.
“I’ve been locked up for three, going on four years,” he said quietly. “I’ve got family that loves me and supports me. The hospital (placement) isn’t here yet. I just want to know if I could get on a (monitoring) box or something?”
Tompsett told him he is doing everything he can to push the MDH toward a meaningful placement.
“I think you will benefit from being in a hospital setting,” Tompsett said, “and working on yourself to get in a position where we can actually discuss what brought you here in the first place.”