Recently, in the case of Leight v. University of Pittsburgh Physicians, et al., No. 35 WAP 2019, the Pennsylvania Supreme Court determined the Pennsylvania Mental Health Procedure Act (MHPA) 50 P.S. §§ 7101-7503, did not apply to a physician’s consideration for a patient’s involuntary emergency examination.
This case arises from a tragic shooting incident on March 8, 2012, wherein John F. Shick, a 30-year-old adult, living independently, killed one person and injured several others at Western Psychiatric Institute and Clinic (“WPIC”) in Pittsburgh. The injured persons included WPIC receptionist Kathryn Leight.
Shick had a long-standing history of mental illness by the time he established a primary care relationship with University of Pittsburgh Physicians (UPP) in June 2011. At that time, he complained of headaches and back, neck, shoulder, chest and ankle pain, which was worked up with various tests and treatments. Shick specifically denied a history of mental illness. By the fall of 2011, UPP determined Shick’s complaints might be because of mental illness, therefore, UPP recommended a mental health evaluation, which was undertaken in November 2011. Thereafter, at UPP’s recommendation, Shick underwent a psychiatric evaluation at which time he denied a mental health history and displayed disorganized thinking but denied suicidal or homicidal ideations. The psychiatrist contacted Shick’s mother, who stated that Shick had five prior psychiatric admissions in Portland, Oregon and did well on the medication Abilify. Shick was diagnosed with schizophrenia and refused to take medication.
From November 2011 through February 10, 2012, Shick had been evaluated by a number of UPP physicians, who all essentially agreed that Shicks complaints of pain were psychosomatic. On February 10, 2012, Shick appeared at UPP brandishing a baseball bat in a threatening manner and was removed from the premises by security. A mental health crisis team was dispatched to Shick’s house for possible involuntary commitment. Shick refused treatment. On February 17, 2012, UPP began the process of completing involuntary commitment papers for Shick. On March 7, 2012, Shick called 911 and was transported to UPMC Presbyterian Hospital for complaints of shortness of breath and parasites in his intestines and eyes. He was refused pain medication and he left the hospital. The next day, Shick went to Western Pennsylvania Psychiatric Institute (WPIC), armed with semiautomatic handguns. In the WPIC lobby, he shot and injured Ms. Leight, who was seated at the receptionist’s desk, and shot several other people, killing one of them, before he was shot and killed by an armed University of Pittsburgh police officer stationed nearby. Ms. Leight suffered gunshot wounds, resulting in internal injuries, including a pneumothorax, and respiratory failure, as well as severe post-traumatic stress disorder.
Leight sued UPP, et al. under the MHPA claiming the physicians caring for Shick were grossly negligent in failing to begin the commitment process by submitting a written application for immediate involuntary examination and treatment to the county administrator pursuant to 50 P.S. § 7302. The MHPA establishes rights and procedures only for the involuntary treatment of mentally ill persons, whether inpatient or outpatient, and for the voluntary inpatient treatment of mentally ill persons. Thus, the voluntary treatment of outpatients falls outside the scope of the MHPA. Based upon Section 114, an affirmative duty exists under the MHPA that requires mental health professionals and institutions to avoid willful misconduct or gross negligence in the treatment of mental health patients and imposes civil liability for a breach of that duty. Goryeb v. Commonwealth, Department of Public Welfare, 575 A.2d 545, 548-49 (Pa. 1990).
The trial court dismissed the case holding that the MHPA did not apply to voluntary outpatient treatment. DeJesus v. United States of America Dept. of Veterans, 479 F.3d 271 (3d Cir. 2007). Additionally, the trial court found that Section 7114(a) did not apply to the physicians who never sought an emergency examination or emergency treatment because these physicians were not participating in a decision that Shick be examined or treated. According to the trial court, because the physicians never initiated the process for seeking an involuntary emergency examination, no decision was ever made as to whether Shick should have been involuntarily examined and received involuntary treatment. Based upon Sections 7103, 7114, and 7302, the trial court reasoned that, since the alleged gross negligence involved voluntary outpatient treatment, all of Shick’s treatment fell outside the scope of the MHPA; thus, it sustained Appellees’ preliminary objections. On appeal, the Pennsylvania Superior Court affirmed the decision of the trial court, and Leight appealed to the Supreme Court.
The Supreme Court examined § 103 of the Act and determined that because Leight did not allege that UPP treated Shick on anything but a voluntary outpatient basis, their treatment fell outside the coverage of the MHPA. The court next examined § 114 of the Act based on Leight’s claim that UPP “participate[d] in a decision that a person be examined or treated” pursuant to Section 114. 50 P.S. § 7114. The Court held “participat[ing] in a decision that a person be examined” under the MHPA is achieved for purposes of Section 114 only afterone of the prerequisites set forth in Section 302 for an involuntary emergency examination is satisfied.