PA Superior Court Distinguishes Involuntary Examination and Voluntary Inpatient Treatment in Denying Health Care Facilities’ Request of Immunity Under the Mental Health Procedures Act

PA Superior Court Distinguishes Involuntary Examination and Voluntary Inpatient Treatment in Denying Health Care Facilities’ Request of Immunity Under the Mental Health Procedures Act

PA Superior Court Distinguishes Involuntary Examination and Voluntary Inpatient Treatment in Denying Health Care Facilities’ Request of Immunity Under the Mental Health Procedures Act

Steven Matos (“Matos”), as the administrator of Jessica L. Frederick’s (“Frederick”) estate brought wrongful death claims, alleging gross negligence, and willful misconduct against Geisinger Medical Center (“Geisinger”) and Alley Medical Center (“Alley”) under the Mental Health Procedures Act (“MHPA”), arising out of Frederick’s death. Summarily, Frederick’s boyfriend, Westley Wise (“Wise”), an individual with acute psychiatric issues, murdered Frederick, on the day he was refused voluntary inpatient examination and treatment at Geisinger and Alley.

Wise suffered cognitive and behavioral issues throughout his childhood and adolescence, including poor judgment and lack of impulse control, as a result of a traumatic brain injury at the age of six when he was thrown from the back of an ATV while riding without a helmet. Between 2005 and 2007, he had been admitted to Geisinger and Alley for alcohol and drug abuse, and mental health issues on multiple occasions. In 2007, he cut the throat of his girlfriend and mother of his two children, Jennifer Karns. He was convicted of simple assault and served 21 months in county jail. In 2011, he was using street drugs; having problems with his employer and Frederick, who was living with him at the time; and his best friend was killed in a drunk driving accident. Wise responded to these events by calling 911 and submitting himself for voluntary inpatient mental health treatment, stating to Geisinger personnel that he “felt suicidal or homicidal,” and felt like he “was going to snap.” Geisinger discharged Wise without administering any treatment; and encouraged him to stop alcohol and street drugs, take daily vitamins, contact the area Service Unit for psychiatrist supervision, and call Tapline if he was suicidal or homicidal or felt worse.

Three days later, Wise, accompanied by his father, presented for inpatient treatment at Alley. Wise’s father told physician Alley personnel that Wise needed help because he feared hurting himself or someone else. Wise told Alley personnel that he had been having hallucinations and delusions, that he was suicidal or homicidal, and that he felt as if he were going to snap. Nevertheless, Alley discharged Wise without treatment. Wise returned home to his apartment, where Frederick asked him to stay the night because he was planning to go to his father’s residence for the foreseeable future. Wise killed Frederick that night and attempted unsuccessfully to kill himself. Wise later pled guilty to third degree murder and is now serving a sentence of imprisonment.

Relying on Leight v. University of Pittsburgh Physicians, 243 A.3d 126 (Pa. 2020), a decision that addressed the involuntary examination process under the MHPA, Geisinger and Alley filed motions for summary judgment, i.e. dismissal, contending they were immune from liability under Section 114(a) of the MHPA, 50 P.S. § 7114(a) because no written application was ever made to admit Wise for voluntary inpatient treatment; and because the MHPA’s plain language does not apply to a physician’s decision-making regarding whether to commit an individual for voluntary inpatient treatment.

Section 7114(a) provides: (a) In the absence of willful misconduct or gross negligence, a county administrator, a director of a facility, a physician, a peace officer or any other authorized person who participates in a decision that a person be examined or treated under this act, or that a person be discharged, or placed under partial hospitalization, outpatient care or leave of absence, or that the restraint upon such person be otherwise reduced, or a county administrator or other authorized person who denies an application for voluntary treatment or for involuntary emergency examination and treatment, shall not be civilly or criminally liable for such decision or for any of its consequences.

In Leight, the Supreme Court addressed whether health care professionals could be liable under Section 7114 for failure to initiate the application process for an involuntary emergency examination at a mental health facility. The Court in Leight held that the plain language of Section 103 of the MHPA, 50 P.S. § 7103, makes clear that the MHPA does not extend to voluntary outpatients; it applies “only to inpatients and involuntary outpatients.” Leight, 243 A.3d at 139. Accordingly, because there was no suggestion that the defendant physicians in Leight treated the patient on anything but a voluntary outpatient basis, the Court concluded that the physicians’ treatment actions fell outside the coverage of the MHPA.

In this case, the Superior Court determined that prerequisites to triggering application of the MHPA were not the same for involuntary examination, the process analyzed in Leight, and voluntary inpatient treatment, the process Wise attempted to exercise. The Court further explained that while the MHPA requires a written application to begin the involuntary examination process, it does not require a written application to begin voluntary inpatient examination and treatment. Thus, according to the Court, Geisinger and Alley may be held liable for refusal to provide voluntary inpatient examination and treatment to a person who submits himself for examination and treatment when the refusal constitutes willful misconduct or gross negligence. Matos v. Geisinger Medical Center, et al., 2023 PA SUPER 38 (Pa. Super. March 23, 2023).