Matos, S. v. Geisinger Medical Center ( 2023 )

J-A14017-22, J-A14018-22
2023 PA SUPER 38
STEVEN MATOS, INDIVIDUALLY AND AS IN THE SUPERIOR COURT
ADMINISTRATOR OF THE ESTATE OF OF PENNSYLVANIA
JESSICA L. FREDERICK, DECEASED
v.
GEISINGER MEDICAL CENTER; MICHAEL
H. FITZPATRICK, MD; RICHARD T.
DAVIES, JR., PA-C; ALLEY MEDICAL
CENTER; DAVID Y. GO, M.D., AND KYLE
C. MAZA, PA-C
APPEAL OF: ALLEY MEDICAL CENTER;
DAVID Y. GO, M.D.; AND KYLE C. MAZA,
PA-C
No. 1189 MDA 2021
Appeal from the Order Entered June 15, 2021
In the Court of Common Pleas of Columbia County
Civil Division at No: 1067-CV-2013
STEVEN MATOS, INDIVIDUALLY AND AS IN THE SUPERIOR COURT OF
ADMINISTRATOR OF THE ESTATE OF PENNSYLVANIA
JESSICA L. FREDERICK, DECEASED
v.
GEISINGER MEDICAL CENTER; MICHAEL
H. FITZPATRICK, MD; RICHARD T.
DAVIES, JR., PA-C; ALLEY MEDICAL
CENTER; DAVID Y. GO, M.D., AND KYLE
C. MAZA, PA-C
APPEAL OF: GEISINGER MEDICAL
CENTER; MICHAEL H. FITZPATRICK, MD;
AND RICHARD T. DAVIES, JR. PA-C No. 1190 MDA 2021
J-A14017-22, J-A14018-22
Appeal from the Order Entered June 15, 2021
In the Court of Common Pleas of Columbia County
Civil Division at No: 1067-CV-2013
BEFORE: BENDER, P.J.E., STABILE, J., and STEVENS, P.J.E.*
OPINION BY STABILE, J.: FILED: MARCH 10, 2023
In these interlocutory appeals by permission, which we consolidate
under Pa.R.A.P. 513, Appellants, Geisinger Medical Center, Alley Medical
Center, and individuals employed by these entities,1 seek review of the trial
court’s refusal to grant them summary judgment in an action brought by
Appellee, Stephen Matos, administrator of the estate of Jessica Frederick,
deceased, under the Mental Health Procedures Act (“MHPA”), 50 P.S. §§
7101—7503. The record demonstrates that Westley Wise (“Wise”), who had
a record of acute psychiatric issues, submitted himself for voluntary inpatient
examination and treatment by presenting himself at Geisinger and then at
Alley. Medical personnel at both facilities examined Wise but denied his
requests for treatment.2 Wise murdered his girlfriend, Frederick, the same
day that Alley refused treatment. Matos alleges that Geisinger and Alley are
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* Former Justice specially assigned to the Superior Court.
1We will refer to Geisinger and its personnel collectively as “Geisinger” and to
Alley and its personnel collectively as “Alley.” We will refer to Appellee as
“Matos.”
2 We acknowledge that both Geisinger and Alley have at times challenged
whether they in fact examined Wise. For purposes of reviewing this denial of
summary judgment, we will accept the fact that both examined Wise as pled
by Matos, the non-moving party.
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liable for gross negligence and/or willful misconduct because they denied
Wise’s request for treatment. 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 contend
they are not liable under the MHPA because no written application was ever
made to admit Wise for voluntary inpatient treatment. We disagree. The
prerequisites to triggering application of the MHPA are not the same for
involuntary examination, the process analyzed in Leight, and voluntary
inpatient treatment, the process in this case. 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, facilities such as 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. Accordingly, we affirm the
denial of summary judgment and remand for further proceedings.
The evidence, construed in the light most favorable to Matos,
demonstrates that Wise suffered a traumatic brain injury at the age of six
when he was thrown from the back of an ATV while riding without a helmet.
He was in a coma at Geisinger for days but eventually regained consciousness
and then required extensive hospitalization thereafter. The accident left Wise
with ongoing cognitive and behavioral issues throughout his childhood and
adolescence, including poor judgment and lack of impulse control.
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In May 2000, Wise was heavily abusing alcohol and street drugs and
had acute psychological problems. He checked himself into Geisinger for
psychiatric treatment and was placed into an inpatient treatment center for
what he described as a nervous breakdown. He was released after 28 days
of treatment.
Between 2005 and 2007, Wise treated with Alley for mental health
issues, including bipolar disorder. In 2007, while living with Jennifer Karns,
the mother of two of his children, Wise again abused drugs and alcohol and
had significant employment issues. During an argument with Jennifer, Wise
“blacked out” and “snapped,” R.R. 565, and cut Jennifer’s throat with a knife.
Wise was convicted of simple assault and served 21 months in county jail.
In January 2011, Wise again was using street drugs and was having
employment problems and ongoing problems with his live-in girlfriend, Jessica
Frederick. In addition, his best friend died in a drunk driving automobile
accident. On January 21, 2011, Wise reacted to these events by calling for
an ambulance to take him to Geisinger’s emergency room. Wise testified that
he went to Geisinger because he previously had been admitted there for
voluntary psychiatric treatment and was familiar with its admission process.
Wise’s father received a call that night that Wise was going to the hospital for
psychiatric treatment. Wise’s father drove from Pottstown to Geisinger to be
with Wise.
Wise submitted himself for examination and requested inpatient
treatment, stating to Geisinger personnel that he was “suicidal, like I was
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going to snap,” Wise Deposition at 64, that he felt “suicidal or homicidal,” id.
at 65, and that he “felt like I was going to snap. I didn’t feel mentally right
at the time.” Id. Wise recounted his conversation with the psychiatric
physician assistant, Appellant Davies, as follows:
Q. What did you tell him?
A. Just told I felt like I was going to snap. I told him I wasn’t
mentally right, that I wanted to stay there.
Q. You asked him to stay there?
A. Yeah.
Q. Why did you want to stay there?
A. I just wasn’t feeling safe, wasn’t feeling okay.
Q. And how long were you with this . . . physician[] assistant, Mr.
Davies?
A. Maybe 15, 20 minutes.
Q. Did you ask him if you could stay at the hospital?
A. Yeah.
Q. What did he say?
A. He said no.
Q. Did he explain to you why?
A. Basically he was saying I wasn’t bad enough to stay there, more
or less.
Id. at 69.
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Geisinger discharged Wise without admitting him as an inpatient and
without administering any treatment. According to Geisinger’s medical
records, the plan for Wise merely advised 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.
Wise’s father, Barry, informed Geisinger that Wise stated he feared he
would harm himself or another person:
Q. Okay. What did you observe during this interaction?
A. Well, . . . he introduced himself. And I don’t know what his
name was . . . I don’t know.
Q. Okay.
A. [] I asked him, . . . what was going on. And I said, I know he
. . . when I come there, too, I had asked Wes, too. And he said,
I need to stay here. I need to stay here, you know. And I asked
him, I said . . . he wants to be committed and stuff. And he says,
well, he’s not bad enough. And I says, what do you mean, not
bad enough? . . . I said, if a person . . . calls 911 and come here
because . . . they are afraid of doing something or hurting
themselves or somebody, I mean - - and they said, well, you
know, we don’t feel he’s bad enough....
Barry Wise Deposition at 86.
On January 24, 2011, three days after his discharge from Geisinger,
Wise, accompanied by his father, presented for examination and inpatient
treatment at Alley. Wise’s father told physician assistant Maza that Wise
needed help because he feared hurting himself or someone else, “And you
know, I said, you know, I think he needs to be put somewhere so . . . he
needs help. Some help.” Id. at 110. Wise’s father elaborated:
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Q. Okay. Did you tell ... Mr. Maza ... that you believed that Wes
was either a danger to himself or someone else?
A. I said - - this is what I remember saying when we sat there:
You know, I told him about the Geisinger thing. You know, he
called to get help, you know, because he felt he was going to hurt
himself or somebody....
Id. at 113. Wise testified that he told Maza he had been having hallucinations
and delusions, that he was suicidal or homicidal, and that he felt as if he were
going to snap. Wise Deposition at 81-83. Nevertheless, Alley discharged Wise
without further treatment.
Wise returned home to his apartment, where his girlfriend, Jessica
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.
Matos, the administrator of Frederick’s estate, commenced this action
alleging that Geisinger and Alley are liable under the MHPA for gross
negligence and/or willful misconduct in failing to diagnose Wise’s condition
and failing to initiate inpatient treatment. In mid-2017, Geisinger and Alley
each filed motions for summary judgment, claiming, inter alia, that they did
not owe any duty of care to Frederick under the MHPA. In late 2017, the trial
court denied these motions, and in early 2018, the court denied Geisinger’s
and Alley’s motions for reconsideration.
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In April 2019, Geisinger and Alley each filed their second motions for
summary judgment, citing the Superior Court’s decision in Leight3 that
medical providers were not liable under the MHPA for refusing to initiate
involuntary commitment procedures against a patient who subsequently killed
one person and injured several others in a shooting spree. One month later,
the trial court denied Geisinger’s and Alley’s motions.
On June 1, 2021, Geisinger and Alley each filed their third motions for
summary judgment based on our Supreme Court’s decision in Leight
affirming this Court’s decision that the medical providers were not liable under
the MHPA. On June 15, 2021, the trial court denied Geisinger’s and Alley’s
motions but granted them permission to take an immediate interlocutory
appeal to this Court. Geisinger and Alley filed timely petitions for permission
to appeal, and this Court granted both petitions.
Alley raises one issue in its appeal:
Whether [Matos] has a viable cause of action under section 7114
of the Mental Health Procedures Act, when in [Leight], the
Supreme Court expressly limited liability under the Act to
decisions made after treatment had been formally initiated under
the act, which circumstances did not occur in the instant matter?
Alley’s Brief at 9.
Geisinger raises two issues in its appeal:
(1) Whether the precedents established by the Supreme Court of
Pennsylvania in Goryeb v. Commonwealth Dept. of Public
Welfare, 575 A.2d 545 (Pa. 1990) and [Leight], which arise in
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3 202 A.3d 103 (Pa. Super. 2018).
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the context of involuntary examination and treatment under
Article III of the MHPA, apply with equal force to voluntary
examination and treatment under Article II of the Act?
(2) Whether the Supreme Court of Pennsylvania’s precedent in
Leight—which declined to extend a statutory duty to control a
patient for the protection of a third party absent formalization of
the statutory prerequisites necessary to initiate an examination
under the Act—mandates dismissal of this action when the
uncontroverted record establishes that the patient was never
treated under the dictates of the MHPA?
Geisinger’s Brief at 3-4.
Our standard of review of an order granting or denying summary
judgment is well-settled:
We view the record in the light most favorable to the nonmoving
party, and all doubts as to the existence of a genuine issue of
material fact must be resolved against the moving party. Only
where there is no genuine issue as to any material fact and it is
clear that the moving party is entitled to a judgment as a matter
of law will summary judgment be entered. Our scope of review of
a trial court’s order granting or denying summary judgment is
plenary, and our standard of review is clear: the trial court’s order
will be reversed only where it is established that the court
committed an error of law or abused its discretion.
Daley v. A.W. Chesterton, Inc., 37 A.3d 1175, 1179 (Pa. 2012).
Geisinger’s and Alley’s arguments boil down to a few simple points in
support of their argument that they are immune from liability under Section
114(a) of the MHPA, 50 P.S. § 7114(a). Geisinger argues that under Leight
the prerequisites for voluntary inpatient treatment were not met to trigger the
MHPA, since Wise never filled out an application to commence the process for
voluntary inpatient treatment. Geisinger Brief at pgs. 9-10. Similarly, Alley
argues that the MHPA’s plain language does not apply to a physician’s
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decision-making regarding whether to commit an individual for voluntary
inpatient treatment, and that under Leight, the MHPA does not apply where
commitment is considered but not formalized with a written certification or
application by a physician, among other requirements. Alley Brief at pgs. 10-
11.
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.
50 P.S. § 7114. (Emphasis added). “Section 7114 has been characterized as
an immunity provision, as well as providing for a statutory cause of action,
albeit by implication.” Leight, 243 A.3d at 140.
The issue whether Geisinger and Alley are immune under Section 7114
raises a question of statutory interpretation. Id. at 139. Our overriding object
in interpreting a statute is “to ascertain and effectuate the intention of the
General Assembly” in enacting the statute. 1 Pa.C.S.A. § 1921(a). If
statutory language is “clear and free from all ambiguity, the letter of it is not
to be disregarded under the pretext of pursuing its spirit.” Id., § 1921(b).
When the words of a statute have a plain and unambiguous meaning, it is this
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meaning which is the paramount indicator of legislative intent. Leight, 242
A.3d at 139.
In Leight, our Supreme Court, applying statutory construction
principles, 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 trial court and all
parties in the present case argue that Leight supports their respective
positions as to whether Geisinger and Alley properly denied voluntary inpatient
treatment to Wise. Accordingly, we begin with a detailed discussion of Leight
before performing further statutory analysis of Section 7114.
In Leight, the Court considered the viability of an action under the
MHPA against medical providers who considered, but did not initiate, an
involuntary emergency examination under Section 302 of the MHPA, 50 P.S.
§ 7302, against an outpatient named Shick. The plaintiffs alleged that Shick
had a six-year history of mental instability and psychiatric care for depression
and bipolar disorder. He had been involuntarily committed on several
occasions but then released. His outpatient primary care physicians
encouraged him to treat with a psychiatrist, but he repeatedly declined
medication and treatment and became schizophrenic and noncompliant with
his medications. One of his primary care physicians requested paperwork to
begin proceedings to determine if he should be involuntarily committed, but
the physician failed to complete the process. One week after the doctor failed
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to file the paperwork, Shick was sent a letter advising that the practice would
no longer provide care to him. Eight days later, Shick went to a psychiatric
clinic with two loaded firearms and opened fire, killing one person and injuring
several others, including the receptionist. The receptionist and her husband
filed a civil complaint against the primary care physicians, asserting that the
physicians should have begun an involuntary emergency examination under
the MHPA. The trial court sustained the defendants’ preliminary objections to
the MHPA claim and dismissed it for failure to state a cause of action. This
Court affirmed the dismissal of the MHPA claim.
Our Supreme Court accepted the plaintiffs’ petition for allowance of
appeal and ultimately held that the complaint failed to state a cause of action
under the MHPA. The Court began by acknowledging that the General
Assembly’s purpose for enacting the MHPA in 1976 was to assure the
availability of adequate treatment to those who are mentally ill. Leight, 243
A.3d at 130 (citing 50 P.S. § 7102). The legislature, through the MHPA, and
in conformity with principles of due process, sought to assure the availability
of voluntary and involuntary treatment “where the need is great and its
absence could result in serious harm to the mentally ill person or to others.”
Id. The plain language of Section 103 of the MHPA, 50 P.S. § 7103,4 makes
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4 50 P.S. § 7103 provides, “This act 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.”
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clear that the MHPA does not extend to voluntary outpatients; it applies “only
to inpatients and involuntary outpatients.” Leight, 243 A.3d at 139. Because
there was no suggestion that the physicians treated Shick on anything but a
voluntary outpatient basis, the Court concluded that the physicians’ treatment
actions fell outside the coverage of the MHPA.
The plaintiffs argued that the physicians participated in a treatment
decision, and therefore were liable under the MHPA, because they began (but
did not complete) the statutory process for involuntary commitment. The
Court rejected this argument based on its construction of Sections 7114 and
7302. Section 7114, the Court observed, immunizes individuals from liability
who, inter alia, “participate[] in a decision that a person be examined or
treated under [the MHPA],” except in instances of willful misconduct or gross
negligence. Under Section 302, a person can be subjected to an involuntary
emergency examination only if one of three mandatory prerequisites is met:
(1) certification of a physician; (2) warrant issued by the county administrator
authorizing such examination; or (3) application by a physician or other
authorized person who has personally observed actions indicating a need for
an emergency application. Reading Sections 7114 and 7302 together, the
Court concluded that the providers did not “participate” in a decision that Shick
be examined, and therefore were immune from liability, because none of the
three preconditions under Section 302 were met:
‘[P]articipat[ing] in a decision that a person be examined’ under
the MHPA is achieved for purposes of Section [7114] only after
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one of the prerequisites set forth in Section [7302] for an
involuntary emergency examination is satisfied. The
requirements of Section [7302] are exclusive, clear, and
unequivocal. Physicians who never invoke a necessary
requirement for involuntary emergency examination are not, for
purposes of Section [7114], participating in a decision that a
person be examined. It is only when a physician files the required
documentation for involuntary emergency examination that he
becomes a participant in the decision-making process under the
Act.
In addition to the manifest requirements of Section [7302], this
conclusion is supported by the later phrase in Section [7114]
which grants immunity to those “who den[y] an application for
voluntary treatment or for involuntary emergency examination
and treatment.” 50 P.S. § 7114. Clearly, an application cannot
be denied until it is first formally made.
Actions by a physician in an outpatient setting that fall short of
satisfying these mandatory requirements do not transform
voluntary outpatient treatment into involuntary treatment.
Id. at 141 (emphasis added). The Court concluded:
Applying our interpretation of the MHPA’s provisions to the instant
case, we find that Appellees’ physicians never satisfied the
prerequisites for the involuntary emergency examination process
under Section [7302] for Shick. That being the case, the
physicians did not take part in a decision that Shick be examined
or treated under Section [7114], and, therefore, they were not
engaged in an involuntary commitment decision. We reiterate
that mere thoughts, consideration, or steps short of the mandated
Section [7302] prerequisites for initiating an involuntary
emergency examination lie outside of a Section [7114] cause of
action. As Appellees and their physicians never participated in a
‘decision that a person be examined or treated under the [MHPA],’
we are compelled to conclude that Section [7114] is inapplicable
and Appellants’ cause of action was rightfully dismissed.
Id. at 143.
Central to Leight’s conclusion that the physicians were immune from
liability under Section 7114 was its determination that the physicians did not
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satisfy any prerequisite for an involuntary examination. Geisinger and Alley
argue that there is no reason why Leight’s logic should not apply here with
equal force to cases concerning voluntary inpatient treatment. As stated, they
claim no prerequisite for voluntary inpatient treatment occurred because there
was no written application to provide voluntary inpatient treatment to Wise.
We agree that Leight’s logic applies with equal force to this case, but we
reach a different result because the prerequisites for involuntary examination
are not the same as those for voluntary inpatient examination and treatment.
We arrive at this determination by comparing the relevant statutes in the
MHPA relating to its inpatient voluntary and involuntary provisions.
VOLUNTARY INPATIENTS INVOLUNTARY INPATIENTS
50 P.S. § 7201. Persons who 50 P.S. § 7301. Persons who
may authorize voluntary may be subject to involuntary
treatment emergency examination and
treatment
Any person 14 years of age or (a) Persons Subject.--Whenever a
over who believes that he is in person is severely mentally disabled
need of treatment and and in need of immediate treatment,
substantially understands the nature he may be made subject to
of voluntary treatment may submit involuntary emergency
himself to examination and examination and treatment. A
treatment under this act, provided person is severely mentally disabled
that the decision to do so is made when, as a result of mental illness,
voluntarily. A parent, guardian, or his capacity to exercise self-control,
person standing in loco parentis to a judgment and discretion in the
child less than 14 years of age may conduct of his affairs and social
subject such child to examination relations or to care for his own
and treatment under this act, and in personal needs is so lessened that he
so doing shall be deemed to be acting poses a clear and present danger of
for the child. Except as otherwise harm to others or to himself, as
authorized in this act, all of the defined in subsection (b), or the
provisions of this act governing person is determined to be in need of
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examination and treatment shall assisted outpatient treatment as
apply. defined in subsection (c).
50 P.S. § 7202. To whom 50 P.S. § 7302. Involuntary
application may be made emergency examination and
treatment authorized by a
physician--Not to exceed 120
Application for voluntary hours
examination and treatment shall
be made to an approved facility (a) Application for Examination.--
or to the county administrator, Emergency examination may be
Veterans Administration or other undertaken at a treatment facility
agency of the United States upon the certification of a physician
operating a facility for the care and stating the need for such
treatment of mental illness. When examination; or upon a warrant
application is made to the county issued by the county administrator
administrator, he shall designate the authorizing such examination; or
approved facility for examination and without a warrant upon application
for such treatment as may be by a physician or other authorized
appropriate. person who has personally observed
conduct showing the need for such
50 P.S. § 7203. Explanation and examination.
consent.
1) Warrant for Emergency
Before a person is accepted for Examination.-- Upon written
voluntary inpatient treatment, an application by a physician or
explanation shall be made to him other responsible party setting
of such treatment, including the forth facts constituting reasonable
types of treatment in which he grounds to believe a person is
may be involved, and any severely mentally disabled and in
restraints or restrictions to which need of immediate treatment, the
he may be subject, together with county administrator may issue a
a statement of his rights under warrant requiring a person
this act. Consent shall be given authorized by him, or any peace
in writing upon a form adopted officer, to take such person to the
by the department. The consent facility specified in the warrant.
shall include the following
representations: That the person (2) Emergency Examination Without
understands his treatment will a Warrant.-- Upon personal
involve inpatient status; that he is observation of the conduct of a
willing to be admitted to a designated person constituting reasonable
facility for the purpose of such grounds to believe that he is severely
examination and treatment; and that mentally disabled and in need of
he consents to such admission immediate treatment, an[y]
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voluntarily, without coercion or physician or peace officer, or anyone
duress; and, if applicable, that he has authorized by the county
voluntarily agreed to remain in administrator may take such person
treatment for a specified period of no to an approved facility for an
longer than 72 hours after having emergency examination. Upon
given written notice of his intent to arrival, he shall make a written
withdraw from treatment. The statement setting forth the
consent shall be part of the person’s grounds for believing the person
record. to be in need of such
examination.
[Emphasis added].
As can be seen, whereas a written application is a prerequisite to
initiating the involuntary inpatient examination process, no such prerequisite
exists to commence voluntary inpatient examination and treatment.
An involuntary inpatient examination is not the patient’s own choice; he
“is made subject to” examination, 50 P.S. § 7301, when a third person such
as a physician requests examination and treatment, 50 P.S. § 7302. The
applicant is a third person such as a physician, peace officer or other
responsible party. See 50 P.S. § 7302(1) (physician or other responsible
party must file a “written application” for emergency examination); 50 P.S. §
7302(2) (physician, peace officer or person authorized by the county
administrator must file a “written statement” articulating the grounds for an
emergency examination). Under the involuntary inpatient examination
provisions medical providers are deemed immune from liability until “written”
application is filed requesting an involuntary emergency inpatient
examination, as a written application is the prerequisite to initiating this
process. Leight, 243 A.3d at 141. Only after a written application is made
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may a medical provider be liable for denying an involuntary inpatient
examination if denial constitutes willful misconduct or gross negligence. Id.
In contrast, in the case of voluntary inpatient examination and
treatment under Section 201, 50 P.S. § 7201, entitled ”[p]ersons who may
authorize voluntary treatment”, a person may submit himself for voluntary
inpatient examination and treatment. A person typically does so by taking
himself to an emergency room for an evaluation to determine the level of
treatment needed. There are no hearings required for admission. Voluntary
admission to a facility may occur after the person is examined and the
evaluating provider and person agree that he would benefit from
hospitalization. If the person is to be admitted, he is then required to sign a
consent form that documents his rights and describes the proposed inpatient
treatment plan. In short, the prerequisite for triggering voluntary inpatient
examination and treatment is when a person “submit[s] himself” to a facility
requesting examination for inpatient treatment.5 Thus, while we apply
Leight’s rationale that a prerequisite to treatment under the MHPA first be
satisfied before liability may be asserted against a provider under the MHPA,
the prerequisites are different for involuntary inpatient examination and
voluntary inpatient examination and treatment. The only prerequisite
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5 We acknowledge that under Section 202, 50 P.S. § 7202, a person also may
apply to a county administrator or approved agency for voluntary examination
and treatment, a process not relevant to the facts of this case because Wise
presented himself to the Geisinger and Alley facilities seeking voluntary
inpatient examination and treatment.
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necessary to trigger the MHPA’s process for voluntary inpatient examination
and treatment is a person submitting himself to an approved facility
requesting examination and admission for inpatient treatment. Nowhere does
the MHPA require that a written application first be made before the person
submits himself to a facility for examination and treatment. While the
involuntary inpatient examination provisions require a “written” application for
examination and treatment, the term “written” is conspicuously absent from
the MHPA’s voluntary inpatient examination and treatment provisions. The
inclusion of “written” in the involuntary inpatient examination provisions and
its omission from the voluntary inpatient examination and treatment
provisions demonstrates that the legislature did not intend to require written
applications for voluntary inpatient examination and treatment. See Fonner
v. Shandon, Inc., 724 A.2d 903, 907 (Pa. 1999) (where “unless” language
was in one section of Workers’ Compensation Act but not in second section,
legislature had different intent in drafting second section; “where a section of
a statute contains a given provision, the omission of such a provision from a
similar section is significant to show a different legislative intent”). Because
of this difference, the point at which liability may attach under the MHPA
differs as between the involuntary examination and voluntary inpatient
examination and treatment processes. If a facility refuses to examine a
person who presents himself for voluntary inpatient examination and
treatment, or after examination refuses to admit the person for treatment,
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liability may attach if the refusal constitutes willful misconduct or gross
negligence.
The record here reflects that Wise, an individual with a history of acute
psychological problems and a criminal record for assault, visited Geisinger and
verbally requested inpatient treatment, claiming that he was homicidal and
suicidal and about to snap. Geisinger’s medical providers performed an initial
evaluation examination on Wise but declined his request for inpatient
treatment. Three days later, Wise visited Alley and verbally requested
inpatient treatment upon the same bases. Alley’s medical providers
performed an examination but declined Wise’s request for inpatient treatment.
That night, Wise murdered Frederick.
Construed in the light most favorable to Matos, the trial court properly
denied summary judgment to Geisinger and Alley on the narrow question that
was before the court. A prerequisite for liability under the voluntary inpatient
examination and treatment provisions of the MHPA was satisfied when Wise
submitted himself to approved facilities, Geisinger and Alley, for voluntary
inpatient examination and treatment. Geisinger and Alley examined Wise but
denied inpatient treatment. Under Section 7114, Geisinger and Alley
participated in decisions concerning whether to treat Wise for voluntary
inpatient treatment. Therefore, they may be subject to liability if their conduct
constituted willful misconduct or gross negligence.
In an attempt to buttress their argument that the voluntary inpatient
examination and treatment provisions of the MHPA are not triggered until a
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written application is submitted, Geisinger and Alley cite a DHS regulation, 55
Pa. Code § 5100.72, which prescribes that “[w]ritten application for voluntary
inpatient treatment shall be made upon Form MH-781, issued by the
Department.” Id. Reference to completing such a form is found under Section
203 of the MHPA, 50 P.S. § 7203. Geisinger and Alley argue that “shall be
made” required Wise to complete a written application, and since Wise did not
do so, he never became a candidate for voluntary admission, thus shielding
Geisinger and Alley from liability. Appellants either read too much into this
provision or simply misread its purpose. Form 781, entitled “Consent for
Voluntary Inpatient Treatment”, instructs a patient that before signing the
form, his treatment plan should be explained to him and he should be given a
copy of the Patient’s Bill of Rights. This is consistent with Section 7203. The
form then provides for the patient to execute a voluntary consent to inpatient
treatment, acknowledging that (1) he consents to the treatment that has been
explained to him, including applicable medications, examination procedures,
and restrictions, and (2) before discharge, he must give certain advance notice
in writing to those in charge of his treatment. Clearly, the regulation and its
accompanying form concern a different step in the voluntary inpatient
examination and treatment process than what is at issue in this case. The
regulation and form require the patient’s written, informed consent to
treatment after a medical provider examines him and determines that
inpatient treatment is necessary—a step that never took place in this case
because Geisinger and Alley refused to treat Wise.
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J-A14017-22, J-A14018-22
Geisinger and Alley urge that this case will open the floodgates for
lawsuits against medical providers unless we find them immune from suit
under the MHPA. Our job, however, is to apply the law as written. It is up to
our legislature to decide policy issues as to when and under what
circumstances medical providers may be liable for harm. Here, the legislature
has drawn that line only to impose liability if the refusal to treat a person
constitutes willful misconduct or gross negligence. This demanding standard
reflects the legislature’s attempt to strike a balance between the rights of
patients and the ability of medical providers to provide adequate mental health
services. We find our conclusion also to be consistent with the legislature’s
intent to assure the availability of adequate treatment to those who are
mentally ill and where the need is great and its absence could result in serious
harm to the mentally ill person or to others. Leight, 243 A.3d at 130 (citing
50 P.S. § 7102).
Based on our careful review of the law, we conclude that the trial court
properly denied summary judgment to Geisinger and Alley on their claims of
immunity under the MHPA. Accordingly, we affirm the order denying summary
judgment and remand this case to the trial court for further proceedings.6
____________________________________________
6 In reaching our conclusion, we emphasize that we have decided only the
narrow question whether facilities like Geisinger and Alley may be liable for
willful misconduct or gross negligence under the MHPA for failing to admit a
person who submits himself to a facility without a written application for
voluntary inpatient examination and treatment. We offer no opinion as to
whether the evidence in this case thus far can sustain Matos’ action against
(Footnote Continued Next Page)
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Order affirmed. Case remanded to the trial court for further
proceedings. Jurisdiction relinquished.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 3/10/2023
____________________________________________
Geisinger and Alley where the deceased was the victim of Wise, who was
refused voluntary inpatient treatment. See Leight, 243 A.3d at 144-50
(Justice Wecht, concurring) (as to whether mental health professionals have
a duty to protect third parties from harm caused by their patients).
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