Never before had more people accused of crimes in Maryland, but deemed too mentally ill to participate in their own cases, been left languishing in jail than in February, a health department official said in court Monday.

At one point last month, 240 people found incompetent to stand trial because of a mental disease or disorder were waiting to be transferred to a state psychiatric hospitals, said Amelia Tibbett, director of the Maryland Department of Health’s post-acute care unit, which oversees court-ordered hospital placements.

That figure had dropped to 230 by the time Tibbett testified for the health department at a hearing Monday in Anne Arundel County Circuit Court, where Judge Ronald A. Silkworth was considering whether to continue his December order holding the agency in contempt of court and fining it $416,000 for violating a state law.

Maryland law requires the health department to admit a defendant deemed incompetent to stand trial and dangerous within 10 days of a judge’s order.

But with its 1,056 psychiatric beds perpetually full, the department rarely abides by that law.

It takes an average of 54 days for the department to admit patients to its four regional hospitals: Spring Grove Hospital Center in Catonsville, Springfield Hospital Center in Sykesville, Eastern Shore Hospital Center in Cambridge and the Thomas B. Finan Center in Allegany County.

The average wait is approximately six months for the state’s only maximum security psychiatric facility, the Clifton T. Perkins Hospital Center in Jessup, which is reserved for patients accused of violent felony crimes.

“The legislature has told us what the appropriate timing is. That’s 10 days,” Silkworth said. “This is and has been for a long time a crisis of constitutional proportions.”

Silkworth noted that lawmakers described holding severely mentally ill defendants in jail, rather than treating them in hospitals, as a “serious public safety risk and a violation of the United States Constitution” when they passed the 2018 law establishing the 10-day deadline.

“Keeping potentially dangerous, seriously mentally ill defendants from treatment exacerbates their problems and violates their right to due process,” the 2018 law’s preamble reads. “The crisis of delayed treatment for seriously mentally ill and incompetent defendants in Maryland has been foreseeable for many years and well documented, facilitated by a steady reduction of capacity and staff in state hospitals while the demand for forensic beds has remained constant.”

At similar hearings across the state, county detention officials have described squalid conditions on their mental health units, saying people housed there sometimes refused showers and spread feces throughout their cells.

Judges have repeatedly sanctioned the health department, ordering the agency to pay hundreds of dollars to local detention centers for every day they kept defendants past the 10-day deadline. According to Silkworth’s December opinion, the department had been levied with about $2 million in sanctions, not counting the fine he imposed.

Silkworth questioned Tibbett and Assistant Attorney General Musa Eubanks, who represents the health department, about what had been done to ameliorate the longstanding crisis. Since he held the department in contempt and fined them, it has failed to comply with his order to provide biweekly reports on its progress and the problem had only worsened.

“I understand everyone’s frustration,” Eubanks said. “The department is doing the best it can given limited resources.”

Both Eubanks and Tibbett also cited the health department’s changing leadership, with former health secretary Dr. Laura Herrara Scott finishing her tenure last month and new leader Dr. Meena Seshamani starting in April.

Tibbett said coronavirus outbreaks and security and HVAC issues had at times closed the admissions unit at Perkins from December through February. She said funds allocated to add beds at the maximum security hospital went to fix the HVAC problem.

Tibbett said she would implement a “waitlist challenge,” aiming to admit 75 new patients and discharge 15% of the department’s hospital population every month. She offered few details about what would change under the program, but said she expected it to bring the agency into compliance with the 10-day law in a year.

“If everyone tries and does what we’re supposed to do, it should work,” Tibbett said. “We are way not in compliance, but we are trying to make it right.”

Tibbett said a $1.6 million investment from Democratic Gov. Wes Moore’s administration was spent increasing community-based beds to create more capacity to discharge patients from hospitals.

She said she wanted improve how the department checks in with local detention centers to see which people waiting for hospital beds are sickest, or most acute, by adding more clinicians to review medical records. The department’s two-person review team is frequently inundated with thousands of pages of defendants’ medical records, she said.

Tibbett said the department was launching a pilot program in Montgomery County that it hoped to implement statewide. Under that plan, defendants charged with misdemeanors carrying maximum penalties of 90 days or less in jail and found incompetent to stand trial would receive treatment in the community rather than wait for a state hospital bed.

The department and Montgomery County found enough community beds for 13 patients.

“We have to start somewhere,” Tibbett said.

Public defender Ellen Goodman Duffy urged Silkworth to keep the sanctions and contempt finding in place, underscoring that the judge’s ruling in December focused not only on her client’s case, but the entire crisis.

“It seems to me the department hasn’t taken this as seriously as it could,” said Duffy, describing clients who deteriorated behind bars, including the case of one person who spread feces in their cell and another who had delusions about being repeatedly sexually assaulted in jail. “It matters in real human terms that the department get this under control.”

Silkworth said it was “not a close call” that the health department has failed to do anything to absolve itself of the contempt finding or fine.

“It’s beyond clear there has been no plan,” Silkworth said.