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The Pennsylvania Superior Court Declines to Expand Scope of Mental Health Procedures Act

The Pennsylvania Superior Court Declines to Expand Scope of Mental Health Procedures Act

In Leight v. UPMC, the Pennsylvania Superior Court declined to expand the Mental Health Procedure’s Act (“MPHA”) to cover claims concerning voluntary outpatient mental health treatment.

This claim arose from a March 8, 2012 shooting incident, wherein John Shick killed one person and injured several others, including Kathryn Leight, who was working as a receptionist at Western Psychiatric Institute and Clinic (“WPIC”) when the shooting occurred.

Mr. Shick had a long-standing history of mental illness, and ultimately came under the outpatient care of UPMC/WPIC. On February 10, 2012, Shick appeared at his family physician to have blood drawn for testing, and inappropriately brandished a baseball bat in a threatening manner, causing the nurse to be upset. Dr. Weiner reported the incident to “Resolve,” the program within WPIC that, among other functions, takes and responds to calls about involuntary civil commitments, and sends mobile teams to evaluate and transport individuals requiring same. Resolve endeavored to take Mr. Shick to WPIC for evaluation, but Mr. Shick refused.

On February 17, 2012, Dr. Weiner called resolve and spoke with a Resolve clinician, asking to have involuntary commitment papers faxed to him to accomplish the involuntary commitment of Shick. The clinician informed Dr. Weiner that Western Psych does not fax involuntary commitment papers and suggested that Dr. Weiner go to Western Psych to fill out the forms; however, this process was not advanced.

On February 20, Shick was evaluated by UPP orthopedic foot & ankle surgeon, Dr. Prisk, M.D., who recognized that Shick clearly had uncontrolled schizophrenia, and really needed psychiatric care. Dr. Prisk contacted “the case managers” for psychiatric help, who he documented were unable to come. On that same day, another physician, Dr. Kirby called WPIC, on an emergent basis, and spoke with Resolve clinician Valerie Krieger, seeking assistance to have Shick involuntarily committed; however, Dr. Kirby did not attempt to or file a commitment petition. 

On February 28, Dr. Kirby sent Shick a letter notifying him that his practice would no longer provide medical care to him effective thirty days from that date. On March 7, Shick called for and received emergency care at his residence for his complaints of shortness of breath, vomiting blood, and parasites in his intestines and eyes. He was taken to UPMC Presbyterian Hospital's emergency department, where he repeated that history, demanded pain medication, refused to discuss his medications with the examining physicians, and left. 

On March 8, 2012, Shick went to WPIC, armed with 9mm semiautomatic handguns and extra ammunition. In the unguarded WPIC lobby, he shot and injured [Kathryn] at the unprotected receptionist’s desk, and shot several other people, killing one of them, before he was himself shot and killed by an armed University of Pittsburgh police officer stationed nearby, but not in or assigned to WPIC, who responded to reports of the incident.

Kathryn suffered physical injuries in the nature of gunshot wounds to the left chest and abdomen, including entry wounds there and exit wounds from her back, and related internal injuries to her muscles, ligaments, nerves and internal organs, and complications including pneumothorax and respiratory failure. She required intubation and exploratory surgery, and long-term subsequent hospitalizations; she also suffered from post-traumatic stress disorder.

The Leights sued UPMC, and others, alleging gross negligence for UPMC’s failure to warn Kathryn of the dangers associated with Shick. UPMC filed preliminary objections, arguing that there was no duty to warn or protect Kathryn from Shick and that there was no duty owed to Kathryn under the MHPA. The trial court dismissed the Leights’ MHPA claims, finding that the MHPA does not apply to voluntary outpatient treatment.

Upon appeal to the Pennsylvania Superior Court, the Leights argued that the trial court erred in “finding that the absence of mention of voluntary outpatient treatment in the MHPA’s scope language immunized physicians providing voluntary outpatient medical treatment from their grossly negligent involuntary examination decisions.” Further, the Leights argued that the trial court’s interpretation of the MHPA is flawed, as a determination that an involuntary commitment examination is necessary is involuntary, not voluntary, treatment.

The Pennsylvania MPHA establishes rights and procedures for all involuntary treatment of mentally ill persons, whether inpatient or outpatient, and for all voluntary inpatient treatment of mentally ill persons. 50 P.S. § 7103. The immunity provision of the MHPA provides as follows:

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. Id. § 7114(a); see also Farago v. Sacred Heart Gen. Hosp., 562 A.2d 300, 304 (Pa. 1989) (stating that the clear intent for enacting Section 7114 of the MHPA was “to provide limited protection from civil and criminal liability to mental health personnel and their employers in rendering treatment in this unscientific and inexact field.”).

In this case, the Superior Court determined, based upon a plain reading of the MPHA, that while a plaintiff may maintain a cause of action where the parties treating or examining a patient under the MHPA have acted with gross negligence, the MHPA only applies to all involuntary inpatient or outpatient treatment, and voluntary inpatient treatment of mentally ill persons. See 50 P.S. § 7103; see also McNamara by McNamara v. Schleifer Ambulance Serv., Inc., 556 A.2d 448, 449 (Pa. Super. 1989) (stating that the MHPA “establishes rights and procedures for all involuntary treatment and voluntary inpatient treatment of mentally ill persons.”). Thus, the immunity and cause of action provisions under section 7114 of the MHPA did not apply to voluntary outpatient treatment. See McKenna v. Mooney, 565 A.2d 495, 496 (Pa. Super. 1989) (holding that section 7103 clearly states that the MHPA does not apply to voluntary outpatient treatment); see also DeJesus v. U.S. Dep’t of Veterans Affairs, 479 F.3d 271, 284 (3d Cir. 2007) (noting that “Pennsylvania courts have held that the MHPA does not apply to voluntary outpatient treatment.”).

 

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