Qualified Immunity Protections for Mental Health Providers

Facts of the Case

Westly Wise, who was diagnosed with bipolar disorder, a traumatic brain injury, and problematic use of alcohol and drugs, had a long history of mental health challenges and impulse control problems. Although he underwent voluntary inpatient psychiatric stays and outpatient treatment, he continued to struggle with stability. In 2007, Mr. Wise “blacked out” and “snapped,” leading to a violent stabbing of his then live-in girlfriend and the mother of his two children. He pleaded guilty to simple assault and served a 21-month jail sentence.

In 2011, Mr. Wise lost his best friend, faced financial difficulties, and began drinking alcohol and using drugs again. He started experiencing severe anxiety, perceptual disturbances, and suicidal thoughts, which caused him to seek help at Geisinger Medical Center’s emergency room for voluntary inpatient psychiatric admission. There, a psychiatric physician’s assistant evaluated and discharged him home with instructions to abstain from drugs and alcohol, take vitamins, establish care with a psychiatrist, and call the county’s behavioral health crisis line if his symptoms worsen.

Three days later, Mr. Wise, who continued to experience severe agitation and hallucinations, was taken to Alley Medical Center by his father out of concern that Mr. Wise might harm himself or others. A physician’s assistant examined Mr. Wise and released him home with a refill of his prescribed medication but without arranging additional mental health treatment. That evening, Mr. Wise returned to his shared apartment with Jessica Frederick and their daughter. Mr. Wise fatally stabbed Ms. Frederick and tried to end his own life with a medication overdose. The administrator of the decedent’s estate filed a lawsuit against both medical centers and the medical personnel involved in the care for Mr. Wise for wrongful death and gross negligence in refusing inpatient treatment for Mr. Wise.

The defendants unsuccessfully filed three separate joint motions for summary judgment. They first argued that they owed no duty to the decedent, Ms. Frederick. But the trial court rejected this claim based on the Supreme Court of Pennsylvania’s 1990 decision in Goryeb v. Commonwealth Department of Public Welfare, 575 A.2d 545 (Pa. 1990), which established liability for gross negligence under the MHPA in mental health treatment decisions where foreseeable harm occurs.

In two additional motions for summary judgment, the defendants made arguments based on Leight v. University of Pittsburgh Physicians, UPMC, 202 A.3d 103 (Pa. Super. Ct. 2018) (Leight I) and Leight v. University of Pittsburgh Physicians, UPMC, 243 A.3d 126 (Pa. 2020) (Leight II). The defendants argued that Mr. Wise’s evaluations were outside the scope of the MHPA. They cited a prior court decision, which held that the MHPA did not apply to voluntary outpatient treatment. The defendants argued that the MHPA did not apply to Mr. Wise because he was evaluated on an outpatient basis from their emergency rooms and was never admitted as an inpatient. They added that Mr. Wise’s request for admission never qualified as an MHPA evaluation because he did not submit the request in writing. The trial court denied the defendants’ second and third motions for summary judgment.

The Pennsylvania Supreme Court granted review to consider whether Leight II should be interpreted to require a person requesting voluntary inpatient treatment to formally initiate the process via written application.

Ruling and Reasoning

The Pennsylvania Supreme Court upheld the superior court’s decision that the Leight II case did not apply and that the MHPA’s liability and immunity provisions are relevant when a patient verbally requests voluntary inpatient psychiatric admission. In a 6-1 ruling, the court explicitly stated that a written request is not always necessary to activate MHPA obligations. The court clarified that “the duty of medical personnel …begins at the moment the [patient] initiates the examination and treatment process by requesting inpatient treatment from an approved facility” rather than when a written consent form is signed (Matos, p 309).

The court examined the structure of Form MH-781, Pennsylvania’s written consent for voluntary inpatient treatment, noting that, even if such a form were required for voluntary admission, sections of the form, such as the “Initial Evaluation and Treatment Plan,” involve collaborative input from both the patient and the medical provider and are not typically something the patient could complete alone. Additionally, the court agreed with the administrator’s argument that patients in mental health crises might not have the wherewithal to complete such a form prior to coming to the emergency room or ask for it at the time of evaluation.

Dissent

Justice Wecht dissented, raising concern that the assumption that verbal requests for voluntary inpatient psychiatric admission are a valid pathway for the MHPA could be seen as an extralegal interpretation of the state’s civil commitment laws. Justice Wecht also noted that Section 110(a) of the MHPA explicitly mentions that all nonprivately funded applications for commitment-related paperwork are “to be in writing” to comply with the Section 110(b) (1978) requirement to submit all applications to the county administrator. Furthermore, Justice Wecht said that broadening the scope of liability for mental health providers could lead to a potential increase in defensive medicine practices and inpatient psychiatry admissions.