Pennsylvania Superior Court Interprets Mental Health Procedures Act to Include Emergency Department Discharges Following Treatment

The non-precedential Pennsylvania Superior Court decision in Hancock v. Friends Hosp., et. al., NO: 1666 EDA 2014 (Pa. Super., March 9, 2015) interpreted and applied the limited civil immunity provision and gross negligence standard under Section 7114(a) of the Pennsylvania Mental Health Procedures Act (“MHPA”)(50 P.S. 7103 et. seq). This opinion addressed the unanswered question regarding the MHPA’s applicability to voluntary mental health Emergency Department (“ED”) visits and treatment without hospital inpatient admission. The MHPA provides a limited shield to providers of mental health services from the sometimes unforeseeable and unpredictable consequences of providing care. As mental health professionals know all too well, and the recent Germanwings crash tragically demonstrates, the treatment of mental illness is both challenging and fraught with risk. In summary, this opinion suggests that a gross negligence standard governs the care provided by ED mental health providers when providers discharge a patient from the ED after deciding that inpatient care is not justified.

In Hancock, plaintiff voluntarily presented to the Friends Hospital Emergency Department on July 20, 2010. By way of history, Plaintiff reported suicidal ideation earlier in the day. Plaintiff also said that he had changed his mind regarding suicide before the ED presentation. There was no record that Plaintiff intended to harm his wife. In the ED he was seen and treated by mental health professionals. He was discharged from the ED that same evening. Two days after discharge, on July 22, 2010, plaintiff attempted suicide and, in subsequent further distress, crashed his vehicle into the vehicle in which his spouse was an occupant. Plaintiff survived these events. Plaintiff sued, inter alia, Friends Hospital alleging that the hospital was negligent for the failure to admit plaintiff for treatment. Pursuant to the MHPA, the trial court held that the limited immunity provision applied to the voluntary ED presentation and that the facts failed to meet the gross negligence standard required by the MHPA. Summary judgment was granted as a matter of law in favor of defendants.

On appeal, the Superior Court affirmed the trial court on the applicability of the MHPA to these facts. Significantly, and as a threshold issue, plaintiff argued that because he voluntarily presented to the Friends Hospital ED and was treated as an outpatient the MHPA was inapplicable. Plaintiff argued in relevant part that the MHPA would have applied only had he been a voluntary inpatient. The Superior

Court disagreed holding that under a “plain reading” of the MHPA, the decision not to admit plaintiff for voluntary inpatient treatment as well as any of the decision’s consequences were covered by the MHPA. The treatment, care and diagnosis decisions were viewed by the Superior Court in the context of deciding whether inpatient care was indicated. There was no dispute that Plaintiff voluntarily presented to the ED seeking inpatient care. Plaintiff was evaluated by Friends Hospital personnel trained in mental health treatment. As a result, a treatment decision was made not to admit Plaintiff for inpatient care. The trial court and Superior Court agreed that the hospital was afforded the benefit of MHPA limited immunity. Therefore, the Superior Court reviewed the facts under the MHPA Section 7114(a) gross negligence standard and affirmed the trial court holding that as a matter of law there was no gross negligence. On summary judgment, the trial court can correctly take the case from the jury and decide if the facts rise to the level of gross negligence as a matter of law. The Superior Court found it significant that plaintiff changed his mind about suicide prior to presenting to Friends Hospital and later declared that he “wanted to live.” These statements were evidence that Friends Hospital was not grossly negligent in discharging plaintiff.

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