In the Int. of: M.T.B. ( 2021 )

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NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
IN THE INTEREST OF: M.T.B. : IN THE SUPERIOR COURT OF
: PENNSYLVANIA
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: No. 115 MDA 2021
Appeal from the Order Entered January 13, 2021
In the Court of Common Pleas of Centre County Civil Division at No(s):
20-3107
BEFORE: NICHOLS, J., KING, J., and MUSMANNO, J.
MEMORANDUM BY NICHOLS, J.: FILED: AUGUST 16, 2021
Appellant M.T.B. appeals from the order involuntarily committing him
for psychiatric treatment with Appellee The Meadows Psychiatric Center
(Meadows). Appellant challenges the sufficiency of evidence for his
commitment pursuant to 50 P.S. § 7304. We affirm.
We state the facts as set forth by the trial court:
This matter commenced when an Application for Involuntary
Emergency Treatment under [50 P.S. § 7302] of the Mental Health
Procedures Act [(MHPA)] was completed on December 13, 2020
by Emily Miller, M. Ed. Ms. Miller noted that [at the time of the
application,] Appellant was a patient at [the Meadows] with a 72
hour notice.[1] Appellant was originally in the Meadows voluntarily
for treatment. Appellant continued to report hearing voices and
was vague with his treatment providers about the voices, stating,
“I’m listening.” Within the prior thirty (30) days, it was noted
Appellant hit his roommate and it was discovered he possessed a
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1 See 50 P.S. § 7203 (stating that a person may be accepted for voluntary in-
patient treatment for up to 72 hours).
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knife in his belongings. Appellant told his treatment providers he
could have pulled the knife out. [The assault and discovery of
Appellant’s knife occurred between December 10 and 13, 2020.
See § 7302 Application, 12/13/20; see also § 7303 Application,
12/18/20.] Ms. Miller noted Appellant was refusing all
medications, had no insight into treatment, and was a danger to
himself and others. Dr. Anokwuru[2] completed the physician’s
examination portion of the [Section 7302] application. He noted
that Appellant is a 30 year-old male with a diagnosis notable for
paranoid schizophrenia and unspecified mood disorder. He was
admitted for suicidal behavior and presented with greatly limited
insight and a labile mood with impulsivity and unpredictability. In
the treatment needed section, Dr. Anokwuru indicated Appellant
required medication management to help stabilize his mood. [The
Section 7302 application was granted on December 13, 2020].
An Application for Extended Involuntary Treatment under [50 P.S.
§ 7303] was filed in this matter on December 18, 2020. In the
Physician’s Examination part of the application, the physician
wrote, the patient presented to the Meadows on December 10,
2020 with thoughts of killing himself and possibly others. A knife
was found with his possessions and he stated if he left the
hospital, he would return immediately and would pull his knife on
someone. [See § 7303 Application, 12/18/20.] Appellant was
diagnosed with severe borderline personality disorder with
psychosis and paranoid schizophrenia. Appellant was refusing to
take his prescribed medications. The treatment needed was
Haldol with Benadryl, group therapy, and supportive counseling.
It was further noted that Appellant would need help coping with
his homelessness and limited family support. The physician
indicated by checking the relevant box that the patient continued
to be severely mentally disabled and in need of involuntary
inpatient treatment, outpatient, partial hospitalization, or a
combination.
[On December 18, 2020, the mental health review officer, Sonja
Napier, Esq., filed a certification finding] Appellant to be severely
mentally disabled and in need of involuntary treatment. She [also
certified that Appellant] be committed to inpatient treatment at
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2 Dr. Anokwuru’s first name was not in the record.
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the Meadows Psychiatric Center or a designated treatment facility
for a commitment period not to exceed twenty (20) days.[3]
Appellant’s need for inpatient treatment persisted and on January
5, 2021, [the Meadows] filed a [50 P.S. § 7304] Application
seeking continued involuntary inpatient treatment. Dr. Orlando
Davis, M.D. completed the Results of Examination portion of the
application. Dr. Davis noted Appellant was admitted with severe
borderline psychosis, marked ambivalence, rambling speech,
guarded nature, and was refusing to take his medication regularly.
He further noted Appellant was unable to speak in a manner that
made sense or was realistic about his discharge plans or housing
options and continued to be unable to provide for his own welfare
and safety. Dr. Davis further noted medication was started over
Appellant’s objection with a second physician opinion having been
obtained.
Trial Ct. Op., 3/16/21, at 1-3 (formatting altered).
On January 5, 2021, a hearing pursuant to Section 7304(b) was held
before Attorney Napier. See 50 P.S. § 7304(b), (e)(6). The trial court
summarized the hearing as follows:
Participating in the hearing were the Appellant; Dr. Orlando Davis,
M.D., the psychiatrist for the Meadows; David Crowley, Esquire,
Appellant’s attorney via speakerphone; Mary Ann Kresan, Esquire,
the attorney for the Meadows via speakerphone; and [Attorney]
Napier, the Mental Health Review Officer, via speakerphone. Dr.
Davis is a psychiatrist and the Medical Director of the Meadows
Psychiatric Center. Dr. Davis was the treating physician for
Appellant and had examined Appellant in connection with the
[Section 7304] hearing. Dr. Davis testified that since the [Section
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3 The trial court, on December 21, 2020, entered an order “finding Appellant
to be in need of inpatient treatment pursuant to [50 P.S. § 7303] and ordered
that Appellant be committed to inpatient treatment at the Meadows Psychiatric
Center or other designated, approved facility for a period not to exceed twenty
(20) days.” Trial Ct. Op. at 3 (some formatting altered). The trial court’s
order was unnecessary for a Section 7303 application, as certification by the
mental health review officer was sufficient. See 50 P.S. § 7303(e).
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7303] proceeding, Appellant continued to be diagnosed with
borderline psychosis and paranoid schizophrenia. He was unable
to provide for his basic needs including health, safety, welfare,
and nutrition without the assistance he was receiving. He was
lacking housing and unable to provide for his own survival
including food and shelter and was unable to communicate his
needs coherently to others. Appellant was not fully compliant with
his medications as he was, at times, declining to take the
medication prescribed -- Haldol and Benadryl. Appellant was on
appropriate doses of the medications but Dr. Davis needed to
determine if the doses needed to be adjusted once Appellant was
actually compliant with taking the medication as prescribed.
Appellant was offered growth therapy and supportive therapy in
which he had participated. He was also provided psychotherapy
and supportive case management in which he partially
participated because Appellant was unable to identify a place he
could live when he would leave the hospital. Due to his housing
issues, his next level of care could not be determined. Dr. Davis
testified there was a reasonable probability of death, disability, or
serious physical debilitation within thirty (30) days if Appellant
was not subject to further involuntary inpatient treatment.
Dr. Davis was specifically concerned Appellant would return
quickly to the Meadows if further inpatient treatment was not
provided, based on Appellant’s behavior demonstrated in the past
when Appellant returned to the Meadows very soon after he was
discharged.[4] Upon returning, Appellant had a knife in his
possessions which was later disclosed and he had ideas that he
might want to kill himself. [N.T. Hr’g, 1/5/21, at 16.] He was
ambivalent and speculated he might pull the knife when he would
come back again after being discharged. Dr. Davis noted if he
could not work with Appellant to find him a place to live where
Appellant will receive the necessary ongoing treatment,
Appellant’s behavior was likely to continue upon release.
Dr. Davis further noted Appellant was a clear and present danger
as he was on “aggression precautions” since he struck another
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4 The record does not establish when, if at all, Appellant was discharged.It
appears Dr. Davis was referring to the events of December 10-13, 2020, when
Appellant indicated that if he left the Meadows, he would return and “would
pull his knife out on someone.” See § 7303 Application.
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person in his room. [Dr. Davis testified that] Appellant had not
struck another person for “some time,” so he would likely be
released soon from aggression precautions. [N.T. Hr’g at 13.] In
connection with his aggression, Dr. Davis stated if Appellant takes
his medication properly, he anticipates that will allow Appellant to
communicate better so he is better understood to enable Appellant
to get help and treatment services once released.
Dr. Davis was seeking continued inpatient treatment which was
the least restrictive treatment option for Appellant, which
treatment would include medication management, therapies as
appropriate, discharge planning, and assistance with accessing
community resources. Appellant was in opposition to the
medication prescribed and Dr. Davis noted the hospital got a
second opinion from a physician regarding medication. The doctor
also stated that Appellant’s improvement was extremely slow
because of his ambivalence and because he was only willing to
take medication at times. At other times, he would hear voices
and talk of having been lobotomized years ago at the Meadows.
Trial Ct. Op. at 4-6 (formatting altered); see N.T. Hr’g at 1-28.
Appellant also testified at the Section 7304 hearing, but his testimony
was frequently incoherent and nonresponsive. Appellant admitted to striking
another person and disagreed with his schizophrenia diagnosis. N.T. Hr’g at
20-21, 27-28. Appellant “was working on” a place to live with family, but
“was not too sure,” but he did not testify about any definitive housing options.
Id. at 22-23. Appellant asserted that he did not want to be involuntarily
committed but wanted to work with the Meadows. Id. at 25. Appellant did
not testify about the knife or harming himself or others.
Based upon the Section 7304 hearing, Attorney Napier filed a report on
January 5, 2021, which concluded, in part, as follows:
1. It was shown by clear and convincing evidence, that [Appellant]
is severely mentally disabled within the meaning of [50 P.S. §
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7304]. As a result of mental illness [Appellant] is a danger to
himself and others.
2. Inpatient treatment at the Meadows . . . is the least restrictive
treatment to treat [Appellant] adequately.
Report, 1/5/21, at 3 (unpaginated).
On January 13, 2021, the trial court reviewed Attorney Napier’s report,
stated it was “satisfied by clear and convincing evidence that [Appellant was]
in need of inpatient treatment pursuant to” Section 7304 and ordered
Appellant committed to inpatient treatment for up to ninety days at the
Meadows.5 Order, 1/13/21.
On January 21, 2021, Appellant filed a timely notice of appeal from the
January 12, 2021 order.6 Notice of Appeal, 1/21/21. Appellant also timely
filed a court-ordered Pa.R.A.P. 1925(b) statement.
Appellant raises the following issue:
Did the government lack sufficient evidence to involuntarily
commit Appellant to involuntary psychiatric treatment as it failed
to present clear and convincing evidence of conduct supporting a
reasonable probability that death or serious physical debilitation
or bodily injury were likely imminent if he were not forced into
treatment?
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5 In sum, prior to the January 12, 2021 order, Appellant was subject to
voluntary treatment for three days, involuntary treatment for five days
pursuant to a Section 7302 application, and involuntary treatment for twenty
days pursuant to a Section 7303 application.
6 A post-trial motion is not required to preserve issues for appeal. In re
K.L.S., 934 A.2d 1244, 1249 (Pa. 2007). We add that even if Appellant has
been released from the involuntary ninety-day treatment period, the appeal
is not moot. See In re R.D., 739 A.2d 548, 553 (Pa. Super. 1999).
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Appellant’s Brief at 4.
Appellant argues that the Meadows “did not present clear and convincing
evidence that involuntary psychiatric treatment was necessary to avoid likely
death, serious bodily injury, or serious physical debilitation.” Id. at 14
(referencing Section 7301(b)(2)(i)). In Appellant’s view, the Meadow’s
evidence was “sheer speculation that his inability to acquire housing would
likely cause him to use a knife to kill himself or another.” Id.
Appellant summarizes Com. ex rel. Gibson v. DiGiacinto, 439 A.2d
105 (Pa. 1981) (Gibson II), rev’g, 395 A.2d 938 (Pa. Super. 1978) (Gibson
I), and argues that the Gibson II Court reversed an involuntary commitment
based on insufficient evidence that the patient “posed a clear and present
danger to himself and others.” Appellant’s Brief at 14. Appellant compares
the facts of his case to the facts in Gibson II, and he asserts that the facts in
Gibson II were even more egregious than the facts of his case.
This Court reviews determinations pursuant to the MHPA to “determine
whether there is evidence in the record to justify the [hearing] court’s
findings.” In re S.M., 176 A.3d 927, 935 (Pa. Super. 2017) (citation omitted).
This Court is “not bound by the hearing court’s legal conclusions and must
reverse if the evidence does not justify the hearing court’s decision.” Gibson
II, 439 A.2d at 107 (citations omitted).
We briefly summarize the MHPA:
The MHPA provides for involuntary emergency examination and
treatment of persons who are “severally mentally disabled and in
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need of immediate treatment.” 50 P.S. § 7301(a). It then
authorizes increasingly long periods of commitment for such
persons, balanced by increasing due process protections in
recognition of the significant deprivations of liberty at stake.
Accordingly, in applying the MHPA, we must take a balanced
approach and remain mindful of the patient’s due process and
liberty interests, while at the same time permitting the mental
health system to provide proper treatment to those involuntarily
committed to its care.
S.M., 176 A.3d at 930-31 (some citations omitted and formatting altered).
Section 7301(a) explains when a mentally disabled person may be
subject to involuntary treatment:
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, as defined in [50 P.S. § 7301(b) . . .].
50 P.S. § 7301(a).
Section 7301(b)(1) defines clear and present danger of harm to others,
and Section 7301(b)(2) defines clear and present danger of harm to himself,
in relevant part as follows:
(1) . . . . For the purpose of this section, a clear and present
danger of harm to others may be demonstrated by proof that the
person has made threats of harm and has committed acts in
furtherance of the threat to commit harm.
(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, supervision and the continued
assistance of others, to satisfy his need for nourishment,
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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; . . . .
50 P.S. § 7301(b)(1), (2)(i).
Section 7304 permits court-ordered involuntary treatment for up to
ninety days. Id. § 7304(g). Section 7304(a)(2) states the criteria for
involuntary treatment of a person that is currently subject to involuntary
treatment:
(2) Where a petition is filed for a person already subject to
involuntary treatment, it shall be sufficient to represent, and upon
hearing to reestablish, that the conduct originally required by
section [7301(b)] in fact occurred, and that his condition
continues to evidence a clear and present danger to himself or
others . . . . In such event, it shall not be necessary to show the
reoccurrence of dangerous conduct, either harmful or debilitating,
within the past 30 days.
Id. § 7304(a)(2). The S.M. Court clarified Section 7304(a)(2) as follows:
[T]he petitioner need not relitigate the initial commitment and . .
. the trial court may consider a patient’s original commitment as
contained in that patient’s commitment history as long as the
patient’s commitment history shows that the requisite behavior
occurred in the past. If the patient challenges that original
commitment, the burden is on the patient to show that the original
commitment was improper.
S.M., 176 A.3d at 936 (citations omitted and formatting altered).
In sum, a Section 7304(a)(2) petitioner must prove two factors. First,
the petitioner, at a hearing, must “reestablish” the patient’s prior conduct,
which qualified as a clear and present danger to himself, to others, or both,
“in fact occurred.” See 50 P.S. §§ 7301(b)(1)-(2), 7304(a)(2). Second, the
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petitioner must establish the patient’s condition continues to evidence a clear
and present danger to himself or others. Id. § 7304(a)(2).
In Gibson II, the patient was in prison when the appellee filed a petition
for court-ordered involuntary treatment. See Gibson II, 439 A.2d at 106.
The appellee had to establish that the patient, within the past thirty days, was
a clear and present danger to himself or others. See id. Specifically, the
appellee had
to show an overt act involving attempted suicide or self-mutilation
or the infliction or threat of serious bodily harm to others to
support the finding. In the absence of such an overt act, actions
indicating inability to satisfy his own need for nourishment,
personal or medical care, shelter, or self-protection and safety
must be shown.
Id. at 107 (citations omitted). The appellee presented testimony that the
patient had extinguished a burning newspaper in his prison cell, did not take
scheduled doses of his medication, and “possessed a twisted piece of
coathanger.” Id. at 106; Gibson I, 395 A.2d at 941-44. As a result, the trial
court ordered that the patient be committed involuntarily, and this Court
affirmed. Gibson II, 439 A.2d at 105-06; Gibson I, 395 A.2d at 945.
The patient appealed to our Supreme Court, which held that the appellee
did not establish that the patient was a clear and present danger to himself or
others. Gibson II, 439 A.2d at 107. In the Gibson II Court’s view, there
was no evidence that (1) the patient deliberately set the newspaper on fire,
(2) the patient’s behavior was changed as a result of not taking his
medication; and (3) the patient “used or threatened to use” the coathanger
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to injure himself or others. Id. The Gibson II Court concluded that because
the record did not establish “an overt act involving attempted suicide or self-
mutilation or the infliction or threat of serious bodily harm to others,” or the
patient’s inability “to attend to his needs as to threaten death [or] serious
bodily injury,” the Gibson II ordered that the patient be released. Id.
Here, as set forth above, Appellant argues that the Meadows presented
insufficient evidence that he posed a clear and present danger to himself. See
Appellant’s Brief at 14. The Meadows, however, presented testimony that in
early December 2020, a knife was discovered in Appellant’s belongings and
that “he might want to kill himself.” See N.T. Hr’g at 11; Trial Ct. Op. at 4-6.
Therefore, the instant record is unlike the record in Gibson II, in which no
evidence was presented that the patient “used or threatened to use” the
coathanger to injure himself. See Gibson II, 439 A.2d at 107.
Dr. Davis also testified that Appellant was diagnosed with severe mental
illness and was unable to provide for his own welfare and safety, including
shelter. See N.T. Hr’g at 13, 16; Trial Ct. Op. at 3. In contrast, in Gibson
II, the issue of the patient’s shelter was not at issue since the patient was in
prison. See Gibson II, 439 A.2d at 107. Here, Appellant has been unable
to acquire housing and did not testify that he had definitive housing options,
which was not an issue in Gibson II. Compare N.T. Hr’g at 22-23, with
Gibson II, 439 A.2d at 107.
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Finally, although Appellant disagreed with his schizophrenia diagnosis,
Appellant did not present any other testimony disputing Dr. Davis’s testimony.
See N.T. Hr’g at 20-21, 27-28. For these reasons, we disagree with
Appellant’s argument that the Meadows did not present clear and convincing
evidence of Appellant’s clear and present danger to himself, including self-
harm and inability to satisfy his need for shelter. See Appellant’s Brief at 14;
50 P.S. § 7301(b)(2)(i). Therefore, Appellant’s reliance on Gibson II fails.
Most importantly, the record supports the trial court’s finding that
Appellant is a clear and present danger to others, which satisfies the statutory
requirements for a Section 7304(a)(2) commitment. Both the Meadows and
Appellant presented testimony that Appellant struck his roommate in early
December 2020. See N.T. Hr’g at 11, 20; Trial Ct. Op. at 4-6. The Meadows
also presented testimony that Appellant was ambivalent about killing someone
else, he possessed a knife in his belongings, and that he might pull the knife
on someone after being discharged. See N.T. Hr’g at 11, 16; Trial Ct. Op. at
4-6. The Meadows acknowledged that Appellant had not struck another
person in “some time” and would soon be released from “aggression
precautions.” N.T. Hr’g at 13. Further, Meadows’ witness testimony
established that Appellant was not fully compliant with his medications and
that he declined to take prescribed medication. Id. at 13, 16. Nonetheless,
the record would also support a determination that Appellant’s prior conduct
was a clear and present danger to others, and given Appellant’s opposition to
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medication, Appellant would continue to pose a danger to others. See S.M.,
176 A.3d at 935.
Finally, the record does not establish that the Meadows ever asserted
that Appellant’s “inability to acquire housing would likely cause him to use a
knife to kill himself or another.” See Appellant’s Brief at 14. Rather, the
Meadows has consistently alleged that Appellant’s mental illness posed a
danger to himself and others. See, e.g., Report, 1/5/21, at 3. For these
reasons, we affirm the trial court’s order because the record supports the trial
court’s findings based on clear and convincing evidence. See S.M., 176 A.3d
at 935.
Order affirmed.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 08/16/2021
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