J.A. v. Montgomery County

J-A01036-23
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
J.A. : IN THE SUPERIOR COURT OF
: PENNSYLVANIA
Appellant :
:
:
v. :
:
:
MONTGOMERY COUNTY, HORSHAM : No. 1362 EDA 2022
CLINIC, PENNSYLVANIA STATE :
POLICE, BRYN MAWR HOSPITAL, :
MONTGOMERY COUNTY EMERGENCY :
SERVICE :
Appeal from the Order Entered May 12, 2022
In the Court of Common Pleas of Montgomery County Civil Division at
No(s): 2021-24235
BEFORE: LAZARUS, J., NICHOLS, J., and McCAFFERY, J.
MEMORANDUM BY LAZARUS, J.: FILED APRIL 11, 2023
J.A. appeals from the order, entered in the Court of Common Pleas of
Montgomery County, denying his petition for review, and affirming the
certification for extended involuntary commitment under subsection 7303
(section 303) of the Mental Health Procedures Act (MHPA).1 Upon careful
review, we affirm.2
____________________________________________
1 50 P.S. §§ 7101-7503.
2 The court’s order provides:
AND NOW, this 12th day of May, 2022, upon consideration of
[J.A.]’s petition for review of 302 and/or 303 certifications, and
responses thereto, it is hereby ordered as follows:
(Footnote Continued Next Page)
J-A01036-23
J.A. was seventeen years old when his parents, both healthcare
professionals,3 filed a petition for involuntary commitment of their son, fearing
for his and their own safety. J.A.’s father reported that J.A.’s “paranoia,
grandiosity, and dysregulated mood has severely escalated over the past 30
days—police had to be called three times to calm him and protect us[;] CYS
and Mobile Crisis have also come to our home several times over [the] past
30 days[.]” Application for Involuntary Emergency Examination and
Treatment (Section 302 Petition), 2/20/21. J.A.’s father and mother also
reported that J.A. had made verbal threats toward them, that J.A. believed
they were stealing his mail, and that J.A. believed his mother was trying to
poison him. Id.
____________________________________________
1. To the extent that [J.A.] seeks review of the certification of the
302 application by respondent Bryn Mawr Hospital Clinic
pursuant to 50 [P.S. §] 7302[,] the petition is DENED.
2. To the extent that [J.A.] seeks review of the certification of the
303 application by respondent Horsham Clinic pursuant to 50
[P.S. §] 7303(g), the petition is DENIED.
3. To the extent [J.A.] seeks expungement, pursuant 50 [P.S. §]
6111(g)(2), of petitioner’s commitment on or about February
21, 2021, under section 302 of the [MHPA], 50 P.S. [§] 7302,
the petition is DENIED.
4. To the extent [J.A.] seeks expungement, pursuant to 18
Pa.C.S.[A. §] 6111(g)(2), of [his] commitment on or about
February 23, 2021, under section 303 of the [MHPA], 50 P.S.
[§] 7303, the petition is DENIED.
Order, 5/12/22.
3 J.A.’s father is a psychiatrist, and his mother is a registered nurse.
-2-
J-A01036-23
J.A. was evaluated by Tracy Bunius, M.D., a psychiatrist, who concluded
that, based upon the circumstances that existed on February 20, 2021, J.A.
was severely mentally disabled and in need of treatment and inpatient
psychiatric admission for stabilization and safety.4 See 50 P.S. § 7301.
____________________________________________
4 Section 7301(a) provides in relevant part:
(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,
as defined in subsection (b)[].
(b) Determination of Clear and Present Danger.--(1) Clear
and present danger to others shall be shown by establishing that
within the past 30 days the person has inflicted or attempted to
inflict serious bodily harm on another and that there is a
reasonable probability that such conduct will be repeated. If,
however, the person has been found incompetent to be tried or
has been acquitted by reason of lack of criminal responsibility on
charges arising from conduct involving infliction of or attempt to
inflict substantial bodily harm on another, such 30-day limitation
shall not apply so long as an application for examination and
treatment is filed within 30 days after the date of such
determination or verdict. In such case, a clear and present danger
to others may be shown by establishing that the conduct charged
in the criminal proceeding did occur, and that there is a reasonable
probability that such conduct will be repeated. 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.
50 P.S. § 7301(a), (b).
-3-
J-A01036-23
Pursuant to subsection 7302 of the MHPA (section 302), J.A. was involuntarily
committed at Bryn Mawr Hospital. He was subsequently transferred to
Horsham Clinic on February 21, 2021, where he was admitted for mental
health treatment. See id. at § 7302.5
J.A. was treated at Horsham Clinic for two days. After examination and
evaluation, James Yi, M.D., a board-certified psychiatrist, submitted a request
that the court certify J.A. for extended section 303 involuntary treatment.
See 50 P.S. § 7303.6 See also Section 303 Application for Extended
Involuntary Treatment, 2/23/22; Attending Psychiatrist Evaluation/Admission
History and Examination, 2/22/21, at 6 (Doctor Yi indicating J.A. “[d]angerous
to self, others, or property with need for controlled environment.”).
A hearing was held before a mental health review officer (MHRO) on
February 25, 2021, at which J.A.’s father, Dr. Yi, and J.A. testified. See 50
P.S. § 7303(b).7 At the conclusion of the hearing, the MHRO determined
that the section 303 commitment was appropriate. See Certification for
Extended Involuntary Emergency Treatment -Section 303 , 2/25/21, at 4
(“Petitioner has produced clear and convincing evidence that patient is a clear
____________________________________________
5Pursuant to section 302, emergency treatment is limited to up to 120 hours
(5 days). See 50 P.S. § 7302(d).
6Pursuant to section 303, emergency treatment is limited to up to 20 days.
See 50 P.S. § 7303(h).
7 “Within 24 hours after the [section 303] application is filed, an informal
hearing shall be conducted by a judge or by a mental health review officer
and, if practicable, shall be held at the facility.” 50 P.S. § 7303(b).
-4-
J-A01036-23
and present danger to [him]self or others. Psychiatric testimony established
that patient is severely mentally disabled, and in need of continued
treatment.”). Fourteen days later, on March 11, 2021, J.A. was discharged
from Horsham Clinic. See id. at § 7303(h).
The MHPA provides for review of a section 303 commitment as follows:
If the judge or MHRO certifies that an extended section 303 commitment is
appropriate, the committed person may petition the court of common pleas
for review of the certification. Id. at § 7303(g). The trial court must hold a
hearing “within 72 hours after the petition is filed unless a continuance is
requested by the person’s counsel.” Id. “The hearing shall include a review
of the certification and such evidence as the court may receive or require.”
Id. “If the court determines that further involuntary treatment is necessary
and that the procedures prescribed by the [MHPA] have been followed, it shall
deny the petition. Otherwise, the person shall be discharged.” Id.
Here, after various filings, including a December 13, 2021 “Petition for
Expungement of Mental Health Records,”8 J.A. filed, on February 16, 2022, a
____________________________________________
8 As a matter of state law, 18 Pa.C.S.A. § 6105(c)(4) prohibits an individual
who has been involuntarily committed to a mental institution for inpatient care
and treatment from possessing or using a firearm. Counsel for Horsham Clinic
represented to the court that J.A. wants to “apply for ROTC scholarships, and
based on [J.A.’s] representations, that would require that he have access to
and possess firearms.” N.T. Conference, Petition for Expungement of Mental
Health Records, 1/6/22, at 13. Since involuntary commitment under the
MHPA is an impediment to firearm license eligibility, that impediment would
be lifted had the trial court invalidated the section 303 commitment, or if that
commitment were ultimately invalidated on appeal. J.A. would then be able
(Footnote Continued Next Page)
-5-
J-A01036-23
petition for review9 of the section 303 certification in the court of common
pleas, pursuant to section 7109(b).10 Although J.A.’s petition was not timely
____________________________________________
to challenge his section 302 commitment pursuant to 18 Pa.C.S.A. §
6111.1(g)(2) for purposes of removing that barrier to his eligibility for a
firearm license.
Pursuant to 18 Pa.C.S.A. § 6111.1(g)(2), if the court, on review, determines
the evidence insufficient to support a section 302 involuntary
commitment, “the court shall order that the record of the commitment
submitted to the Pennsylvania State Police [PSP] be expunged.” Notably, in
In re J.M.Y., 218 A.3d 404 (Pa. 2019), our Supreme Court stated that “this
section, by its terms, empowers a court to entertain a petition testing the
sufficiency of the evidence for a Section 302 commitment; however, it does
not authorize a court to consider whether a certification for
involuntary mental health treatment pursuant to [s]ection 303 was
validly entered[.]” Id. at 416, citing In re Vencil, 152 A.3d 235, 245 (Pa.
2017) and In re Jacobs, 15 A.3d 509, 511 (Pa. Super. 2011) (emphasis
added). See also In re Vencil, supra at 245 (“A sufficiency review pursuant
to section 6111.1(g)(2) of the Uniform Firearms Act is merely a mechanism
to expunge the PSP’s record of an individual’s 302 commitment to remove this
barrier to his or her possession and control of firearms.”). See J.M.Y., supra
at 415-17 (concluding that neither 18 Pa.C.S.A. § 6111.1(g)(2), nor 18
Pa.C.S.A. § 6105(f)(1) of the Uniform Firearms Act provide an avenue for
challenging 7 validity of section 303 commitment).
9 J.A. named Horsham Clinic as defendant. Bryn Mawr Hospital, the County
of Montgomery, Montgomery County Emergency Services, and the
Pennsylvania State Police (PSP) were later joined as additional defendants.
Horsham Clinic and Montgomery County Administrator of Mental Health filed
separate appellee briefs. Pursuant to Pa.R.A.P. 2137, the PSP and Bryn Mawr
Hospital adopted by reference the arguments and conclusions of those briefs.
10See 50 P.S. 7109(b) (“In all cases in which the hearing is conducted by a
[MHRO], a person made subject to treatment shall have the right to petition
the court of common pleas for review of the certification.”).
-6-
J-A01036-23
filed within 30 days of the February 25, 2021 section 303 certification, 11 J.A.
sought, and was granted, permission to file a nunc pro tunc petition for review.
See Order, 2/22/22.12
On May 10, 2022, a review hearing13 was held before the Honorable
Bernard A. Moore.14 At the hearing, Judge Moore heard testimony from J.A.’s
father, Dr. Yi, Kelly Bonomo (a therapist at Horsham Clinic who had been
involved in therapeutic sessions with J.A. and who communicated with J.A.’s
parents), and J.A. Judge Moore also reviewed the following: the section 303
petition, which included the section 302 petition and notes from Dr. Yi’s
examination; the section 303 certification by the MHRO, which contained a
summary of the evidence presented at the section 303 hearing; the audiotape
of the section 303 hearing; a summary of the transcript from section 303
____________________________________________
11 See In re K.L.S., 934 A.2d 1244 (Pa. 2007) (certification constitutes final
adjudication from which appeal must be taken within 30 days); see also 42
Pa.C.S.A. § 5571(b) (“[A]n appeal from a tribunal or other government unit
to a court . . . must be commenced within 30 days after the entry of the order
from which the appeal is taken[.]”).
12 See In re J.M.Y., supra at 419 (Pennsylvania Supreme Court stating that
“nothing in this Opinion should be construed as constraining [J.M.Y.’s] present
ability to petition for review of the Certification, nunc pro tunc, based on these
alleged procedural irregularities[.]”).
13While a trial court's review of a 303 commitment does not require a full, de
novo hearing, it does require some hearing. In re T.J., 739 A.2d 478 (Pa.
1999). Because the MHRO cannot enter a final order, the review hearing
before the trial court is akin to a de novo hearing. Id. at 480.
14 J.A. represented himself at the review hearing.
-7-
J-A01036-23
hearing; the psychosocial assessment and therapeutic notes from therapist
Bonomo, and the text of section 301 of the MHPA. See N.T. Review Hearing,
5/10/22, at 6-39; Defense Exhibits D-1 through D-5; Plaintiff’s Exhibits P-1
and P-2.
Following the hearing, Judge Moore denied J.A.’s petition for review.
J.A. filed this timely appeal and raises one issue for our review: “Did the
learned trial judge err in upholding the 303 petition?” Appellant’s Brief, at 3
(unnecessary capitalization omitted).15
J.A. argues that the examining physician’s findings were insufficient to
support certification for extended involuntary inpatient treatment under
section 303 of the MHPA because he was never found to be a danger to himself
and that, as far as whether he was a danger to others, his “alleged threat
directed at [his parents] was ambiguous at best.” Appellant’s Brief, at 6, 11.
J.A. contends that “despite the fact that there was no basis for a 302
[commitment,] a 303 [p]etition was filed requesting additional inpatient
treatment under Section 303(b)(1) or (2) by James Yi, [M.D.,] psychiatrist.”
Id. at 11. J.A. also argues that the testimony at the review hearing “confirmed
that [J.A.] was neither a danger to himself or others” as defined in the MHPA.
We disagree.
____________________________________________
15 Although the trial court’s order purports to deny J.A.’s petitions to expunge
the 302 and 303 commitments, the issue of expungement is of no moment
unless the court determines, following a review hearing, that the section 303
involuntary commitment was invalid.
-8-
J-A01036-23
Our standard of review16 for an involuntary commitment order under
the MHPA is to “determine whether there is evidence in the record to justify
the court’s findings.” In re S.M., 176 A.3d 927, 935 (Pa. Super. 2017).
“Although we must accept the trial court’s findings of fact that have support
in the record, we are not bound by its legal conclusions from those facts.” Id.“The burden is on the petitioner to prove the requisite statutory grounds by
clear and convincing evidence.” Id. at 937 (citation and quotation marks
omitted). “Our Supreme Court has defined clear and convincing evidence as
testimony that is so clear, direct, weighty, and convincing as to enable the
trier of fact to come to a clear conviction, without hesitation, of the truth of
the precise facts in issue.” Id. (citations and internal quotation marks
omitted). Further, the MHPA is to be strictly construed. Commonwealth v.
Moyer, 595 A.2d 1177, 1179 (Pa. Super. 1991) (citation omitted).
Following are the specific allegations in the 302 petition, which was
admitted into evidence at the section 303 review hearing:
[J.A.’s Father:] My son’s paranoia, grandiosity and dysregulated
mood has severely escalated over the past thirty (30) days—
police had to be called three times to calm him and protect us,
CYS and Mobile Crisis have also come to our home several times
over the past thirty (30) days. Today my son would not allow his
mother to leave the home to retrieve our mail from the post office,
he threatened my wife in my presence that she could not leave
the home without him. Then he jumped on the hood of her car
while she was backing out and would not get off until the police
____________________________________________
16 We note that J.A.’s appellate brief does not include this Court’s scope or
standard of review, as required by Pa.R.A.P. 2111(a)(3).
-9-
J-A01036-23
arrived. Mobile Crisis workers witnessed the incident firsthand. I
was also present as he jumped on the car.
[J.A.’s Mother:] I tried to leave my home today to get our mail at
the post office and my son insisted that I could not go without him
as he is paranoid and was convinced that I would steal his mail.
He physically attempted to block me from leaving the home. Then
when I finally made it to my car and locked the doors, he jumped
on the hood of my car as I was backing out of the garage and
continued to voice threats that I could not leave. Last week when
he was unhappy about something I did, he told me “I would rue
the day” and “Don’t worry, a surprise is coming for you.” He would
not allow me to make him dinner a couple of weeks ago because
he thought I was going to poison him.
Application for Involuntary Emergency Examination and Treatment (Section
302), 2/20/21. See also Kelly Bonomo, Psychosocial Assessment, 2/22/21
(Exhibit P-2) (“Pt is a 17 y/o male admitted involuntarily due to increasing
paranoia, delusional thoughts, and erratic and violent behavior. Pt attempted
to disallow mother from leaving house.”); N.T. Review Hearing, supra at 33
(Kelly Bonomo testifying in response to questioning by J.A.: “I had written in
this that there was a concern about threats of violence, but not anything
specific. And you had jumped on the moving car.”).
J.A.’s father’s testimony from the section 303 hearing was also admitted
into evidence at the review hearing. See Summary of Transcript of Section
303 Hearing, 2/25/2117 (J.A.’s father stating [J.A.’s] paranoia increased as did
his verbal aggression toward us [.] He would stand outside our bedroom door,
[and] he would get a chair and stay there all night talking to keep us awake.
____________________________________________
17This Court has reviewed the audio recording of the section 303 hearing,
which included testimony from J.A.’s father, Dr. Yi, and J.A.
- 10 -
J-A01036-23
. . . I called the police 3 times to our house over the past 30 days, [and] I had
mobile crisis over our house twice within past 30 days[.]”).
Doctor Yi’s findings following his examination of J.A., set forth in the
section 303 application, were also admitted into evidence at the review
hearing:
Patient is a 17 y/o boy with history of paranoia who was admitted
with worsening paranoia and behaviors that are worsening for
safety. He was admitted after he tried to stop his mother from
driving to the post office by jumping [on]to her car. More recently,
he had more bizarre behavior[,] including filling the mailbox with
books, believing that M[other’s] food is poison, impersonating his
father to earn money, diverting his emails to different states, and
also continuously suing the school district. Father also reports
worsening verbal threats to the point that parents do not feel safe
at night.
Application for Extended Involuntary Treatment (Section 303), 2/23/21, at 3.
On cross-examination, in response to J.A.’s question on identifying
“suicidal or homicidal behavior” in the application, Dr. Yi responded:
A: You were not admitted because of suicidal ideation. . . . [Y]ou
were here for worsening paranoia and behaviors that are
concerning for safety. And there are several examples here that
[are] listed, including stopping your mother from driving to
the post office by jumping on to her car[,] . . . filling the
mailbox with books, believing mom’s food is poison,
impersonating your father to earn money, diverting his mail to [a]
different state and also continuously suing the school district.
Your father was reporting worsening verbal threats to the
point that your parents did not feel safe at night.
Q: Was it your opinion that I was a clear and present
danger to myself or to others when you filed this?
A: Yes.
- 11 -
J-A01036-23
Review Hearing, 5/10/22, at 23 (emphasis added).
J.A. argues that the threats to his mother, that she “would rue the day,”
and “Don’t worry, a surprise is coming for you[,]” are “ambiguous at best,”
and, thus, cannot be construed as satisfying section 301’s requirement that
the individual pose “a clear and present danger of harm to others.”
Appellant’s Brief, at 15. “Clear and present danger of harm to oneself or
others is defined in the MHPA as “within the past 30 days, the person has
inflicted or attempted to inflict serious bodily harm on another and that there
is reasonable probability that such conduct will be repeated.” 50 P.S. §
7301(b)(1). J.A. argues that the MHPA requires that a finding of clear and
present danger “must be based upon an overt act[.]” Appellant’s Brief, at 18.
In In Re B.W., 250 A.3d 1163 (Pa. 2021), our Supreme Court stated:
From a plain reading of Section 301(b)(1), there are three
alternative formulations of a clear and present danger to others:
(1) the person has inflicted, or attempted to inflict, serious bodily
harm on another in the past 30 days and there is a reasonable
probability the person will repeat that conduct; (2) the person has
been found incompetent to stand trial or acquitted due to lack of
criminal responsibility of charges of inflicting, or attempting to
inflict, serious bodily harm on another, and the petition establishes
the charged conduct occurred and a probability it will be repeated;
or (3) “the person has made threats of harm and has
committed acts in furtherance of the threat to commit
harm.”
Id. at 1173 (quoting 50 P.S. § 7301(b)(1) (emphasis added). The Court
stated that “when the involuntary commitment is based upon the third means
to show a clear and present danger in Section 301(b)(1), i.e., the ‘threats and
- 12 -
J-A01036-23
acts’ formulation, both a threat and an act in furtherance must be proven.”
Id. at 1774.
J.A.’s argument, however, ignores his act—jumping on the hood of his
mother’s car as she attempted to drive away, an act he admitted to Dr. Binius
was “bizarre and dangerous behavior.” See Section 302 Application for
Involuntary Treatment, supra (Doctor Binius’ evaluation, stating: [J.A.]
admits to bizarre and dangerous behavior such as jumping on the hood of a
moving car.”). We decline to find J.A.’s behaviors were a mere threat without
an act in furtherance. On the contrary, we find that J.A.’s behavior, his verbal
threats to his parents, in particular to his mother, combined with his action of
jumping on the hood of mother’s car as she was attempting to drive away,
demonstrates, as Dr. Yi opined, that J.A. was a clear and present danger to
himself and others at the time of the 302 commitment. See N.T. Review
Hearing, supra at 27 (Doctor Yi opining harm to others or to oneself does not
necessarily have to be overt, stating: “[E]ven though you didn’t get hurt, by
jumping onto a car, there is a risk that you could [suffer] bodily injury, [and]
there are other behaviors such as increasing threats to the point that your
parents did not feel safe at home.”).
We accord deference to Dr. Yi’s testimony, “as the physician [who]
examined and evaluated the individual in the first instance, was able to
observe [J.A.’s] demeanor, and has particularized training, knowledge and
experience regarding whether a 302 commitment is medically necessary.” In
re B.W., 250 A.3d at 1176, quoting Vencil, 152 A.3d at 246. The court,
- 13 -
J-A01036-23
therefore, acted properly in refusing to disturb the medical determination of
the examining physician.
We note that in establishing the “clear and convincing” standard of proof
for involuntary treatment:
Whether the individual is mentally ill and dangerous to [either
himself or] others . . . turns on the meaning of the facts which
must be interpreted by expert psychiatrists and
psychologists. . . . The subtleties and nuances of psychiatric
diagnosis render certainties beyond reach in most situations. . . .
Within the medical discipline, the traditional standard . . . is a
“reasonable medical certainty[.]” [The] “beyond a reasonable
doubt” standard would forc[e] reject[ion] [of] commitment for
many patients desperately in need of institutionalized psychiatric
care.
Commonwealth v. Helms, 506 A.2d 1384, 1389 (Pa. Super. 1986), quoting
Addington v. Texas, 441 U.S. 418, 429–30 (1979) (citations omitted)
(emphasis added). As this Court stated in Helms: “The legislature did not
require indisputable proof that an individual’s behavior would be repeated, but
rather proof of the “probability” of such an event, which denotes “a chance
stronger than possibility but falling short of certainty.” Helms, 506 A.2d at
1389, quoting Webster's New World Dictionary, College Edition (1966). Thus,
a petitioner must present evidence demonstrating a substantial likelihood that
the behavior will recur if the individual is not involuntarily committed. Helms,
supra.
We believe that standard has been met here. Viewed in its totality, the
evidence clearly and convincingly demonstrates that there is a reasonable
probability that J.A. would suffer serious bodily injury and/or his threats
- 14 -
J-A01036-23
against his parents would come to fruition. The trial court deemed Dr. Yi’s
testimony credible and sufficient to find that J.A. posed a clear and present
danger to himself or others in the absence of further treatment, as
contemplated by the statute. See 50 P.S. § 7301(b)(1) (“Clear and present
danger to others shall be shown by establishing that within the past 30 days
the person has inflicted or attempted to inflict serious bodily harm on another
and that there is a reasonable probability that such conduct will be
repeated.”). See In re Vencil, supra (trial court’s review limited to findings
recorded by physician and information relied upon in arriving at findings, and
requires deference to physician, as original factfinder, as physician examined
and evaluated individual in first instance, observed demeanor, and has
particularized training, knowledge, and experience regarding whether section
302 commitment is medically necessary).
Based on our review of the record before us, we conclude that the
evidence was sufficient to support Judge Moore’s affirmance of the MHRO’s
order extending J.A.’s involuntary commitment. Accordingly, we affirm order
denying J.A.’s petition for review of the order extending his involuntary
psychiatric treatment.
Order affirmed.
- 15 -
J-A01036-23
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 4/11/2023
- 16 -