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PA Supreme Court to Provide Guidance on Application of the Mental Health Procedures Act

by Brett J. Engelkraut, Esquire

Pennsylvania’s Mental Health Procedures Act (MHPA) provides limited liability protection for physicians, hospitals, and certain other providers who treat patients with “mental illnesses.” Under the MHPA, liability only attaches in cases of “willful misconduct or gross negligence,” and “treatment” is defined to include “diagnosis, evaluation, therapy, or rehabilitation needed to alleviate pain and distress and to facilitate the recovery of a person from mental illness and . . . care and other services that supplement treatment and aid or promote such recovery.”

While the MHPA limits the circumstances under which mental health treatment providers can be sued, the law is ostensibly designed to protect mental health patients by limiting the risks providers face when offering treatment. In theory, if doctors or other medical providers are less likely to be sued, then they will be more willing to provide treatment in potentially high-risk scenarios. However, as a case currently pending before the Pennsylvania Supreme Court demonstrates, the MHPA’s applicability to the treatment of mental health patients is not as clear-cut as the legislature may have intended.

Pennsylvania Supreme Court Hears Oral Arguments in Dean v. Bowling Green Brandywine

The case of Dean v. Bowling Green Brandywine involves the question of whether, and to what extent, the MHPA applies to the treatment of a “mentally ill” patient who sought care at a drug & alcohol treatment center but later died at the facility from an allegedly untreated heart arrhythmia.
According to the intake forms, the patient had a prior medical history that included bipolar disorder and ADHD; he was also diagnosed during his admission with a mood disorder/anxiety disorder.
The MHPA uses the terms “mentally ill” and “mentally ill persons” without definition and states in Section 7103 that it “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.”

Based on this broad language, the defendants in Dean v. Bowling Green Brandywine argued that the MHPA’s liability protections apply to all treatment provided to mentally ill patients and that an anxiety disorder falls within the definition of a mental illness. In contrast, the plaintiffs argued that the patient was admitted for drug detoxification (not mental illness) so the immunity provisions of the MHPA are inapplicable.

At the trial level, the lower court granted a nonsuit based on the plaintiffs’ failure to allege willful misconduct or gross negligence, as required to establish liability under the MHPA. On appeal, the plaintiffs argued that the MHPA was inapplicable because the patient (who was found unresponsive and later died) had sought treatment for drug addiction only. Subsequent to the patient seeking treatment, however, a doctor at Bowling Green ordered the patient to undergo a psychiatric evaluation wherein he was diagnosed with a mood and anxiety disorder. It was this diagnosis, as well as a distant prior history, that brought the MHPA’s applicability into question.

The Superior Court held that some of the patient’s providers were entitled to protection under the MHPA, and some were not. Specifically, it held that Bowling Green and its doctors were immune under Section 7103, while the emergency medical professionals who treated the patient during intermittent visits to the hospital were not immune because they did not provide mental health treatment, and those ED visits occurred prior to the psychiatric evaluation at Bowling Green.

At oral argument, at least one justice on the Pennsylvania Supreme Court seemed to be questioning the appellate court’s reasoning. Justice Kevin Dougherty reportedly opined that, “We have an individual who came in because he needed to get off pills. . . . It wasn’t get off the pills and receive mental health treatment.” The justices also appear to be weighing the question of whether Bowling Green’s mental illness diagnosis (which was not sought by the patient) was enough to bring the facility’s entire course of treatment within the scope of the MHPA; and, if so, what this might mean for the use of mental health diagnoses as shields from medical malpractice liability in future cases.

Summary

Dean v. Bowling Green Brandywine is an interesting case with important implications for doctors, hospitals, drug & alcohol treatment centers, and other health care related facilities throughout Pennsylvania, and we are anxiously awaiting the Pennsylvania Supreme Court’s decision. If you have questions about the protections afforded by the Mental Health Procedures Act or health care providers’ potential liability exposure in Pennsylvania in general, we encourage you to call 412-995-3000 or email us to speak with one of our medical professional liability attorneys.