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November 12th, 2024
Rebecca A. Toth was admitted to the behavioral unit of the Defendant, Chambersburg Hospital (“Hospital”) under section 302 of the Mental Health Procedures Act (“MHPA”), 50 P.S. § 7114. She had a history of dementia and was designated as a high fall risk, requiring staff supervision while ambulating. Over time, hospital staff noted behavior by Mrs. Toth that increased her risk of falling; however, the hospital did not increase the level of supervision to more than one staff person. Ultimately, Mrs. Toth pushed her supervising staff member and attempted to run; however, she tripped and fell. She complained of pain in her hip/pelvis, and despite a recommendation to immediately transfer her to a trauma center, she remained in the behavioral health unit for several days. Mrs. Toth’s complaints continued, and she was transferred to the York Hospital Trauma Center, at which time she was diagnosed with a fracture of her left acetabulum, which required surgery. Despite the surgery, Mrs. Toth passed away days later, allegedly from complications due to a fall and a fracture of the left acetabulum.
The Plaintiff, David B. Toth, commenced a survival and wrongful death action asserting negligence against the hospital. Following the completion of discovery, the hospital filed a Motion for Summary Judgment, asserting the conduct complained of did not establish willful misconduct or gross negligence; in the absence of such conduct, the hospital was immune from civil liability pursuant to the MPHA.
The trial court determined that the MPHA applied to the Plaintiff’s claim and concluded that no reasonable person could conclude that the hospital’s conduct constituted gross negligence or willful misconduct, and therefore, the court granted summary judgment for the Hospital. On appeal to the Superior Court, Mr. Toth argued that the MPHA did not apply to the fact of the case, and even if it did, he developed sufficient evidence to allow a reasonable person to conclude that the hospital’s conduct giving rise to Mrs. Toth’s death constituted gross negligence or willful misconduct.
The MHPA provides that, in the absence of willful misconduct or gross negligence, facilities, physicians, and other authorized people shall be immune from civil and criminal liability for certain decisions related to treatment under the MHPA:
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.
50 P.S. § 7114(a). The Pennsylvania Supreme Court has interpreted “person” to include “hospitals and other treatment facilities as well as their employees,” reasoning that “denying such entities immunity would undermine the goals of the MHPA.” Dean v. Bowling Green-Brandywine, 225 A.3d 859, 869 (Pa. 2020). Treatment is defined in the MHPA as including:
Diagnosis, evaluation, therapy, or rehabilitation is needed to alleviate pain and distress and to facilitate the recovery of a person from mental illness and shall also include care and other services that supplement treatment and aid or promote such recovery.
50 P.S. § 7104. Immunity under the MHPA includes “medical care coincident to mental health care,” which is “commonly understood to include the prevention or alleviation of both physical and mental illness.” Allen v. Montgomery Hospital, 696 A.2d 1175, 1179 (Pa. 1997). Here, the Superior Court agreed with the trial court’s conclusion that Mrs. Toth’s activity of walking when she fell was part of the care plan for her dementia or part of some ancillary physical maintenance that she needed as a patient, and thus, it was covered as “treatment” under section 7104 of the MHPA.
The Superior Court previously defined “gross negligence” in the MHPA context as follows:
It appears that the legislature intended to require that liability be premised on facts indicating more egregiously deviant conduct than ordinary carelessness, inadvertence, laxity, or indifference. We hold that the legislature intended the term gross negligence to mean a form of negligence where the facts support substantially more than ordinary carelessness, inadvertence, laxity, or indifference. The behavior of the defendant must be flagrant, grossly deviating from the ordinary standard of care.
Bloom v. Dubois Reg’l Med. Ctr., 597 A.2d 671, 679 (Pa. Super. 1991). Pennsylvania’s Supreme Court adopted this definition, stating, “This definition is a clear, reasonable, and workable definition of gross negligence which is consistent with the purpose and intent of the [MHPA].” Albright v. Abington Mem’l Hosp., 696 A.2d 1159, 1164 (Pa. 1997) (citing Bloom, 579 A.2d at 697). The Albright Court added, “A court may take the issue of gross negligence from a jury and decide the issue as a matter of law if the conduct in question falls short of gross negligence, the case is entirely free from doubt, and no reasonable jury could find gross negligence.” Id. at 1165.
Mr. Toth did not complain of “gross negligence” in his complaint, and his experts did not mention gross negligence in their reports. Nonetheless, Mr. Toth argued that gross negligence can be inferred from the Hospital’s conduct and the expert’s opinions. However, both the trial court and the Superior Court determined that Mr. Toth’s experts did not use the terms “flagrant” or “gross” to modify the stated deviations from the standard of care. cf. Bourgeois v. Snow Time, 242 A.3d 637, 652 n. 6 (Pa. 2020) (expert report with amplifying language plausibly supported the finding of gross negligence). Accordingly, the Superior Court concluded that no reasonable jury could find that the hospital’s conduct in caring for Mrs. Toth was grossly negligent.
The opinion in the case of Toth v. Chambersburg Hospital, 2024 PA Super 236 (January 17, 2024) can be accessed here.
