In Re: T.R., Appeal of: T.R. ( 2014 )

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NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
IN RE: T.R. : IN THE SUPERIOR COURT OF
: PENNSYLVANIA
:
:
APPEAL OF: T.R. : No. 1037 EDA 2013
Appeal from the Order Entered February 28, 2013
In the Court of Common Pleas of Delaware County
Civil Division at No(s): 3960-11
BEFORE: GANTMAN, P.J., PANELLA, J., and STABILE, J.
MEMORANDUM BY GANTMAN, P.J.: FILED NOVEMBER 06, 2014
Appellant, T.R., appeals from the order entered in the Delaware
County Court of Common Pleas, which denied his petition to expunge his
mental health commitments under the Mental Health Procedures Act
(“MHPA”).1 We affirm.
The relevant facts and procedural history of this case are as follows.
Appellant is a licensed Pennsylvania attorney with a Ph.D. in plant molecular
biology. Since 2006, Appellant has received mental health treatment for
bipolar disorder with depression. Due to his mental illness, Appellant has
not maintained employment since approximately 2007. Appellant also
receives Social Security disability benefits.
On May 24, 2011, Appellant’s treating psychiatrist, Dr. Susan Mitchell,
recommended that Appellant immediately admit himself at Crozer Chester
1
50 P.S. §§ 7101-7503.
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Medical Center (“Crozer”) for a psychiatric evaluation because Dr. Mitchell
believed Appellant was at risk of suicide. The following day, Appellant
presented himself for an emergency psychiatric evaluation at Crozer, where
he reported having severe depression and “vague suicidal thoughts with a
plan.” (See Hearing Exhibit D-3 at 1; R.R. at 57A.) After an emergency
evaluation, which deemed Appellant severely mentally ill and in need of
emergency treatment, Dr. Jacob McCormick, M.D., the attending physician,
signed an application to admit Appellant under 50 P.S. § 7302 for up to 120
hours of involuntary emergency examination and treatment. Appellant
signed the Section 7302 form to acknowledge that he had been notified of
his rights. Appellant received a psychiatric evaluation, an IV for
dehydration, and medication including Lithium. At approximately 6:00 p.m.
on May 25, 2011, Dr. Syed Ali, M.D., met with Appellant and confirmed that
he had been involuntarily committed under Section 7302.
Appellant met with Deanna Chiddick, a social worker, and Dr. Rivera
on May 26, 2011. Ms. Chiddick explained to Appellant that he would meet
with a psychiatrist for Delaware County, who would conduct a psychiatric
examination. Dr. Rivera told Appellant there would be an involuntary
emergency treatment proceeding (“Section 7303 proceeding”) the following
day to determine whether to extend Appellant’s involuntary emergency
treatment under 50 P.S. § 7303. Prior to the Section 7303 proceeding, Dr.
Theodore J. Barry, M.D., the psychiatrist for Delaware County, conducted an
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independent psychiatric examination of Appellant on May 27, 2011. Dr.
Barry reviewed Appellant’s medical records from May 25, 2011, including Dr.
Ali’s report describing Appellant as “agitative, manic, paranoid, [and]
depressed,” refused to take any medication, and verbalized “suicidal
thoughts with a vague plan.” (See Hearing Exhibit C at 7; R.R. at 49A.) Dr.
Barry discussed with Appellant Dr. Ali’s recommendation that Appellant
continue treatment at Crozer, with which Appellant agreed. Dr. Barry then
told Appellant Dr. Barry would inform the Mental Health Review Officer at
the Section 7303 proceeding of Appellant’s agreement to the recommended
treatment, so Appellant would not be put through a formal court hearing.
During Dr. Barry’s examination, Appellant’s court-appointed attorney
for the Section 7303 proceeding, was present outside the open door to Dr.
Barry’s office. Counsel testified he typically listens while Dr. Barry meets
with patients in preparation for Section 7303 proceedings. If the patient
agrees with Dr. Barry to continue the involuntary treatment, counsel
testified he usually does not speak to the patient or interfere with his
decision.
Appellant’s Section 7303 proceeding was held on May 27, 2011, before
a Mental Health Review Officer. Appellant did not attend the proceeding.
Based on Appellant’s acquiescence to continue treatment, the Mental Health
Review Officer ordered Appellant to receive up to twenty days of extended
involuntary treatment under Section 7303. Appellant was subsequently
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released from Crozer on May 31, 2011. Appellant has had no hospital
admissions due to his mental illness since that time.
On April 26, 2012, Appellant filed a petition to expunge his mental
health commitments, pursuant to 50 P.S. §§ 7109(b) and 7303(g) of the
MHPA.2 The trial court conducted an evidentiary hearing on December 3,
2012. On February 28, 2013, the court issued findings of fact and
conclusions of law, and denied Appellant’s petition. Appellant timely filed a
notice of appeal on March 27, 2013. The court ordered Appellant on April 3,
2013, to file a concise statement of errors complained of on appeal pursuant
to Pa.R.A.P. 1925(b), and Appellant timely complied on April 24, 2013.
Appellant raises the following issues for our review:
WHETHER THE TRIAL COURT ERRED AS A MATTER OF LAW
AND/OR ABUSED ITS DISCRETION BY DENYING
[APPELLANT’S] PETITION FOR EXPUNGEMENT OF HIS
INVOLUNTARY MENTAL HEALTH COMMITMENTS.
WHETHER THE INITIAL INVOLUNTARY COMMITMENT OF
[APPELLANT] AT CROZER CHESTER HOSPITAL PURSUANT
TO THE MENTAL HEALTH PROCEDURES ACT, 50 P.S. §
7302, WAS INAPPROPRIATE AND UNLAWFUL BECAUSE
EVIDENCE DEMONSTRATES THAT [APPELLANT] DID NOT
“[ACT] IN SUCH A MANNER AS TO EVIDENCE THAT HE
WOULD BE UNABLE WITHOUT CARE, SUPERVISION AND
THE CONTINUED ASSISTANCE OF OTHERS, TO SATISFY
HIS NEED FOR NOURISHMENT, PERSONAL OR MEDICAL
CARE, SHELTER, OR SELF-PROTECTION AND SAFETY, AND
THAT THERE [WAS] REASONABLE PROBABILITY THAT
DEATH, SERIOUS BODILY INJURY OR SERIOUS PHYSICAL
DEBILITATION WOULD ENSUE WITHIN 30 DAYS UNLESS
ADEQUATE TREATMENT [WAS] AFFORDED.”
2
50 P.S. §§ 7109(b) and 7303(g) contain identical language.
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WHETHER THE INITIAL INVOLUNTARY COMMITMENT OF
[APPELLANT] AT CROZER CHESTER HOSPITAL PURSUANT
TO THE MENTAL HEALTH PROCEDURES ACT, 50 P.S. §
7302, WAS INAPPROPRIATE AND UNLAWFUL BECAUSE
EVIDENCE DEMONSTRATES THAT [APPELLANT] DID NOT
INTEND TO TAKE HIS OWN LIFE NOR DID HE TAKE ANY
ACT IN FURTHERANCE OF ANY PLAN TO HARM HIMSELF.
WHETHER THE EXTENDED INVOLUNTARY COMMITMENT
OF [APPELLANT] AT CROZER CHESTER HOSPITAL UNDER
THE MENTAL HEALTH PROCEDURES ACT, 50 P.S. § 7303,
WAS INAPPROPRIATE AND UNLAWFUL BECAUSE
[APPELLANT] DID NOT KNOWINGLY AGREE TO
CONTINUED INPATIENT TREATMENT OR KNOWINGLY
WAIVE HIS RIGHT TO AN INFORMAL HEARING.
WHETHER THE EXTENDED INVOLUNTARY COMMITMENT
OF [APPELLANT] AT CROZER CHESTER HOSPITAL
PURSUANT TO THE MENTAL HEALTH PROCEDURES ACT, 50
P.S. § 7303, WAS INAPPROPRIATE AND UNLAWFUL
BECAUSE [APPELLANT] WAS DEPRIVED OF DUE PROCESS
OF LAW DURING HIS [“§ 303”] COMMITMENT
PROCEEDINGS IN THAT [APPELLANT] WAS DENIED
ADEQUATE REPRESENTATION OF COUNSEL BY HIS
COURT-APPOINTED ATTORNEY.
WHETHER THE TRIAL COURT ERRED IN FINDING THAT
[APPELLANT] COULD NOT HAVE SUFFERED ANY STIGMA
FROM HIS ILLEGAL COMMITMENTS BECAUSE HE HAS
APPLIED FOR AND RECEIVED SOCIAL SECURITY
DISABILITY BENEFITS, IN THAT THE COURT’S
CONCLUSION DENIES THE DISTINCTION BETWEEN A
BENEFIT THAT APPELLANT IS ENTITLED TO BY LAW
SECURED BY HIM VOLUNTARILY AND AN ILLEGAL
COMMITMENT AND IS CONTRARY TO PENNSYLVANIA LAW.
(Appellant’s Brief at 3-4).
“Our well-settled standard of review in cases involving a motion for
expunction is whether the trial court abused its discretion.” In re Keyes, 83
A.3d 1016, 1022 (Pa.Super. 2013) (citing Commonwealth v. A.M.R., 887
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A.2d 1266, 1268 (Pa.Super. 2005)).
In his first five issues, Appellant argues his involuntary commitment
under Sections 7302 and 7303 of the MHPA was inappropriate and unlawful.
Appellant contends his initial commitment under Section 7302 was unlawful
because there was no evidence Appellant was unable to care for himself,
posed a clear and present danger to himself or others, or refused to eat or
take medication. Appellant claims he presented at Crozer as cooperative,
alert, and well groomed, and at the time of commitment he lived in a stable
home with his wife and two adult daughters. Appellant also alleges he was
not a clear and present danger to himself under the statute because, in the
thirty days prior to his involuntary commitment, Appellant had not intended
to take his own life or committed any act to further a plan to harm himself.
Appellant asserts the staff at Crozer had no reason to commit him under a
provision of the MHPA regarding a risk of suicide.
Appellant also argues his extended involuntary commitment under
Section 7303 was unlawful because he was deprived of his due process
rights during his Section 7303 proceeding. Appellant states he did not
knowingly or intentionally waive his right to a formal hearing under Section
7303, where he was unaware he had a right to a hearing and access to
counsel. Appellant contends no one adequately explained the process when
he agreed to comply with Dr. Ali’s recommendation for continued treatment.
Appellant alleges he mistakenly believed that waiving his right to a formal
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hearing and continuing treatment meant he would be released. Appellant
also claims he was denied adequate representation of counsel because he
did not know counsel had been appointed to represent Appellant. Appellant
maintains counsel’s conduct amounted to ineffective assistance because
counsel did not meet with Appellant or represent Appellant’s interests at the
Section 7303 proceeding, and counsel failed to ensure Appellant understood
that he was waiving his right to a formal hearing. Appellant concludes this
Court must grant Appellant’s expungement petition. We disagree.
Sections 7301, 7302, and 7303 of the MHPA deal with involuntary
emergency examination and treatment of individuals: Section 7301 provides
in relevant part:
§ 7301. Persons who may be subject to involuntary
emergency examination and treatment
(a) Persons Subject.—Whenever a person is severely
mentally disabled and in need of immediate treatment, he
may be made subject to involuntary emergency
examination and treatment. A person is severely mentally
disabled when, as a result of mental illness, his capacity to
exercise self-control, judgment and discretion in the
conduct of his affairs and social relations or to care for his
own personal needs is so lessened that he poses a clear
and present danger of harm to others or to himself.
(b) Determination of Clear and Present Danger.—
* * *
(2) Clear and present danger to himself shall be shown
by establishing that within the past 30 days:
(i) the person has acted in such manner as to
evidence that he would be unable, without care,
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supervision and the continued assistance of others,
to satisfy his need for nourishment, personal or
medical care, shelter, or self-protection and safety,
and that there is a reasonable probability that death,
serious bodily injury or serious physical debilitation
would ensue within 30 days unless adequate
treatment were afforded under this act; or
(ii) the person has attempted suicide and that there
is the reasonable probability of suicide unless
adequate treatment is afforded under this act. For
the purposes of this subsection, a clear and present
danger may be demonstrated by the proof that the
person has made threats to commit suicide and has
committed acts which are in furtherance of the
threat to commit suicide[.] …
50 P.S. § 7301(a), (b)(2)(i)-(ii). Section 7302 provides:
§ 7302. Involuntary emergency examination and
treatment authorized by a physician—not to exceed
one hundred twenty hours
(a) Application for Examination.—Emergency
examination may be undertaken at a treatment facility
upon the certification of a physician stating the need for
such examination; or upon a warrant issued by the county
administrator authorizing such examination; or without a
warrant upon application by a physician or other
authorized person who has personally observed conduct
showing the need for such examination.
(1) Warrant for Emergency Examination.—Upon
written application by a physician or other
responsible party setting forth facts constituting
reasonable grounds to believe a person is severely
mentally disabled and in need of immediate
treatment, the county administrator may issue a
warrant requiring a person authorized by him, or any
peace officer, to take such person to the facility
specified in the warrant.
(2) Emergency Examination Without a Warrant.—
Upon personal observation of the conduct of a
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person constituting reasonable grounds to believe
that he is severely mentally disabled and in need of
immediate treatment, and physician or peace officer,
or anyone authorized by the county administrator
may take such person to an approved facility for an
emergency examination. Upon arrival, he shall
make a written statement setting forth the grounds
for believing the person to be in need of such
examination.
(b) Examination and Determination of Need for
Emergency Treatment.—A person taken to a facility shall
be examined by a physician within two hours of arrival in
order to determine if the person is severely mentally
disabled within the meaning of section 301 and in need of
immediate treatment. If it is determined that the person
is severely mentally disabled and in need of emergency
treatment, treatment shall be begun immediately. If the
physician does not so find, or if at any time it appears
there is no longer a need for immediate treatment, the
person shall be discharged and returned to such place as
he may reasonably direct. The physician shall make a
record of the examination and his findings. In no event
shall a person be accepted for involuntary emergency
treatment if a previous application was granted for such
treatment and the new application is not based on
behavior occurring after the earlier application.
(c) Notification of Rights at Emergency
Examination.—Upon arrival at the facility, the person
shall be informed of the reasons for emergency
examination and of his right to communicate immediately
with others. He shall be given reasonable use of the
telephone. He shall be requested to furnish the names of
parties whom he may want notified of his custody and kept
informed of his status. The county administrator or the
director of the facility shall:
(1) give notice to such parties of the whereabouts
and status of the person, how and when he may be
contacted and visited, and how they may obtain
information concerning him while he is in inpatient
treatment; and
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(2) take reasonable steps to assure that while the
person is detained, the health and safety needs of
any of his dependents are met, and that his personal
property and the premises he occupies are secure.
(d) Duration of Emergency Examination and
Treatment.—A person who is in treatment pursuant to
this section shall be discharged whenever it is determined
that he no longer is in need of treatment and in any event
within 120 hours, unless within such period:
* * *
(2) a certification for extended involuntary
emergency treatment is filed pursuant to section 303
of this act.
50 P.S. § 7302(a)-(c), (d)(2) (internal footnotes omitted). Furthermore,
Section 7303 provides in relevant part:
§ 7303. Extended involuntary emergency treatment
certified by a judge or mental health review officer—
not to exceed twenty days
(a) Persons Subject to Extended Involuntary
Emergency Treatment.—Application for extended
involuntary emergency treatment may be made for any
person who is being treated pursuant to section 302
whenever the facility determines that the need for
emergency treatment is likely to extend beyond 120 hours.
The application shall be filed forthwith in the court of
common pleas, and shall state the grounds on which
extended emergency treatment is believed to be
necessary. The application shall state the name of any
examining physician and the substance of his opinion
regarding the mental condition of the person.
(b) Appointment of Counsel and Scheduling of
Informal Hearing.—Upon receiving such application, the
court of common pleas shall appoint an attorney who shall
represent the person unless it shall appear that the person
can afford, and desires to have, private representation.
Within 24 hours after the application is filed, an informal
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hearing shall be conducted by a judge or by a mental
health review officer and, if practicable, shall be held at
the facility.
(c) Informal Conference on Extended Emergency
Treatment Application.—(1) At the commencement of
the informal conference, the judge or the mental health
review officer shall inform the person of the nature of the
proceedings. Information relevant to whether the person
is severely mentally disabled and in need of treatment
shall be reviewed, including the reasons that continued
involuntary treatment is considered necessary. Such
explanation shall be made by a physician who examined
the person and shall be in terms understandable to a
layman. The judge or mental health review officer may
review any relevant information even if it would be
normally excluded under rules of evidence if he believes
that such information is reliable. The person or his
representative shall have the right to ask questions of the
physician and of any other witnesses and to present any
relevant information. At the conclusion of the review, if
the judge or the review officer finds that the person is
severely mentally disabled and in need of continued
involuntary treatment, he shall so certify. Otherwise, he
shall direct that the facility director or his designee
discharge the person.
* * *
(g) Petition to Common Pleas Court.—In all cases in
which the hearing was conducted by a mental health
review officer, a person made subject to treatment
pursuant to this section shall have the right to
petition the court of common pleas for review of the
certification. A hearing shall be held within 72 hours
after the petition is filed unless a continuance is
requested by the person’s counsel. The hearing shall
include a review of the certification and such evidence as
the court may receive or require. If the court determines
that further involuntary treatment is necessary and that
the procedures prescribed by this act have been followed,
it shall deny the petition. Otherwise, the person shall be
discharged.
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(h) Duration of Extended Involuntary Emergency
Treatment.—Whenever a person is no longer severely
mentally disabled or in need of immediate treatment and,
in any event, within 20 days after the filing of the
certification, he shall be discharged….
50 P.S. § 7303(a)-(c)(1),(g)-(h) (internal footnote omitted) (emphasis
added).
Involuntary commitment under Section 7302 is proper “where there
are reasonable grounds to believe a person is severely mentally disabled and
in need of immediate treatment.” In re Jacobs, 15 A.3d 509, 510
(Pa.Super. 2011) (citing In re Hancock, 719 A.2d 1053, 1055 (Pa.Super.
1998)). “[I]t is not sufficient to find only that the person is in need of
mental health services. It must also be established that there is a
reasonable probability of death, serious injury or serious physical debilitation
to order commitment.” In re R.F., 914 A.2d 907, 913-14 (Pa.Super. 2006),
appeal denied, 593 Pa. 741, 929 A.2d 1162 (2007) (citing In re T.T., 875
A.2d 1123 (Pa.Super. 2005)). “[A] suicide attempt occurs when a person
clearly articulates or demonstrates an intention to commit suicide and has
committed an overt action in furtherance of the intended action.” In re
R.F., supra at 913 (citing 55 Pa. Code § 5100.84(g)). “[C]ommitment
under § 7303 indicates a more serious mental problem[;]…commitment
under § 7302 only requires a doctor’s determination, while commitment
under § 7303 imposes major due process requirements.” Jacobs, supra at
511.
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“[E]xpungement of civil commitment records (be they generated in a
hospital or court context) are required if they originated as a result of an
illegal proceeding subsequently declared null and void[.]” In re R.F., supra
at 909 (citation and internal quotation marks omitted). Nevertheless, this
Court has recently stated: “[W]e are aware of no authority, statutory or
decisional, that provides for the expunction of a mental health commitment
record where commitment was obtained pursuant to 50 P.S. § 7303.”
Keyes, supra at 1024.
Instantly, Appellant presented himself to Crozer per the
recommendation of his treating psychiatrist, Dr. Mitchell. Appellant reported
severe depression, “vague suicidal thoughts with a plan,” “people are after
him,” and “nothing will help me.” (See Hearing Exhibit D-3 at 1; R.R. at
57A; Hearing Exhibit B at 5; R.R. at 40A.) Dr. McCormick performed an
emergency evaluation and determined Appellant was severely mentally
disabled and in need of immediate emergency treatment. Dr. McCormick
consequently signed a Section 7302 application for involuntary commitment,
which stated Appellant “was a clear and present danger to himself” because,
within the past thirty days, he had “acted in such manner as to evidence
that [he] would be unable, without care, supervision and the continued
assistance of others, to satisfy [his] need for nourishment, personal or
medical care, shelter, or self-protection and safety” and there was a
“reasonable probability that death, serious bodily injury or serious physical
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debilitation would ensue…unless adequate treatment were afforded[.]” (See
Hearing Exhibit C at 2; R.R. at 44A.) Thus, there were reasonable grounds
to believe Appellant was severely mentally disabled, together with a
reasonable probability of death or serious bodily injury. See Jacobs,
supra; R.F., supra. Appellant signed the Section 7302 application to
acknowledge his admission rights had been explained to him. Accordingly,
Appellant’s Section 7302 commitment was lawful and appropriate; it did not
arise from an illegal proceeding. See R.F., supra.
Furthermore, there is no legal authority to expunge Appellant’s
commitment under Section 7303. See Jacobs, supra; Keyes, supra
(holding there is no way for appellant to remove record of Section 7303
commitment). Moreover, Appellant had the opportunity in 2011 to appeal
his Section 7303 commitment. See 50 P.S. § 7303(g). Nevertheless,
Appellant failed to do so.
The trial court summarized its disposition of Appellant’s first five issues
as follows:
Separate and apart from [Appellant’s] significant suicidal
ideations, he was first admitted to Crozer because he
presented as a patient unable to satisfy his most basic
needs for “nourishment, personal or medical care, shelter
or self-protection and safety,” and for these reasons,
serious bodily injury or death were a “reasonable
probability.” [Appellant’s] commitment under [Section
7302 of the MHPA] was therefore appropriate and lawful.
Based on the evidence of record, this [c]ourt determined
that [Appellant] knowingly agreed to the continued
inpatient treatment at [Crozer] for stabilization of mood,
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behavior, suicidal thoughts and stabilization of
medications. As [Appellant] agreed to further inpatient
treatment and therefore obviated the need for a hearing,
his argument regarding ineffective counsel was moot.
[Appellant’s] commitment under [Section 7303 of the
MHPA] was also appropriate and lawful. As the
commitments were appropriate and lawful, the Petition for
Expungement was appropriately denied.
(Trial Court Opinion, filed May 22, 2013, at 11-12). We accept the court’s
reasoning. Thus, the court properly denied Appellant’s petition to expunge
his commitments under the MHPA. See Keyes, supra. Accordingly,
Appellant’s first five issues merit no relief.
In his final issue, Appellant argues he has suffered shame and stigma
from his involuntary mental health commitments. Appellant alleges the
court improperly interpreted Pennsylvania law when it said that individuals
who suffer from mental illness and apply for Social Security disability cannot
suffer further trauma to their reputation due to an illegal involuntary
commitment. Appellant maintains in very general terms that stigma is
presumed with involuntary commitments because records of those
commitments pose an ongoing threat to an individual’s reputation.
Appellant concludes this Court must grant his expungement petition on this
ground. We cannot agree.
“The Rules of Appellate Procedure state unequivocally that each
question an appellant raises is to be supported by discussion and analysis of
pertinent authority.” Coulter v. Ramsden, 94 A.3d 1080, 1088 (Pa.Super.
2014) (quoting Estate of Haiko v. McGinley, 799 A.2d 155, 161
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(Pa.Super. 2002)) (internal quotation marks omitted). See Pa.R.A.P.
2119(a)-(b). “Appellate arguments which fail to adhere to these rules may
be considered waived, and arguments which are not appropriately developed
are waived.” Coulter, supra.
Here, Appellant’s final issue is arguably waived for failure to develop
his claim regarding the “additional” stigma and shame Appellant suffered
due to his involuntary commitments. Appellant’s argument does not cite any
relevant authority to support his allegation that records of an involuntary
commitment may be expunged based on vague allegations of stigma and
shame. Therefore, Appellant’s final issue is waived.3 See id.; Pa.R.A.P.
2119(a)-(b).
Moreover, even if Appellant’s final issue had been preserved, Appellant
would not be entitled to relief because his commitment under Section 7303
cannot be expunged. See Keyes, supra; Jacobs, supra. Accordingly, we
affirm the court’s order denying Appellant’s petition for expungement of his
mental health commitments.
Order affirmed.
3
Appellant’s final issue fundamentally turns on Appellant’s allegations of the
“illegality” of his commitments, which we have already determined, on this
record, were legal.
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Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 11/6/2014
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