J-S33031-23

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT O.P. 65.37

IN RE: M.B.

APPEAL OF: M.B.

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 IN THE SUPERIOR COURT OF

 PENNSYLVANIA

 No. 205 WDA 2023

Appeal from the Order Entered January 23, 2023

In the Court of Common Pleas of Allegheny County Orphans’ Court at 

No(s): CC: 18 of 2023

BEFORE: BENDER, P.J.E., McCAFFERY, J., and STEVENS, P.J.E.*

MEMORANDUM BY STEVENS, P.J.E.: FILED: October 20, 2023

Appellant M.B. appeals from the January 23, 2023, order entered in the 

Court of Common Pleas of Allegheny County Orphans’ Court, which 

involuntarily committed her for inpatient psychiatric treatment with St. Clair 

Memorial Hospital. M.B. challenges the sufficiency of the evidence for her civil 

commitment pursuant to Section 7304 of the Mental Health Procedures Act 

(“MHPA”).

1

 After a careful review, we affirm.

The relevant facts and procedural history are as follows: On January 4, 

2023, the Allegheny County Department of Human Services Office of 

____________________________________________

* Former Justice specially assigned to the Superior Court

1 50 P.S. §§ 7101-7503.
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Behavioral Health (“DHS”) presented a petition for commitment under Section 

7303 of the MHPA requesting the emergency involuntary inpatient civil court 

commitment of M.B at St. Clair Memorial Hospital. On that date, M.B. 

stipulated to the recommendation of Bruce Wright, M.D. (“Dr. Wright”), that

she be committed for not more than twenty days, and Mental Health Review 

Officer Jennifer Price (“MHRO Price”) issued a certification. Thus, M.B.’s 

involuntary commitment was set to expire on January 23, 2023. 

However, prior to the expiration of M.B.’s emergency involuntary 

commitment, on January 13, 2023, DHS filed a petition under Section 7304

of the MHPA seeking additional involuntary inpatient commitment of M.B. for 

a period not to exceed ninety days due to her continued dangerous behavior. 

The petition contained a notation that M.B. was unable to sign an informed 

consent form, and DHS attached to the petition a proper notice with intent to 

file a petition for extended involuntary treatment.

On January 20, 2023, a tele-health hearing was conducted before MHRO 

Price regarding the Section 7304 petition.

2

 At the hearing, Dr. Wright, who is 

a board-certified psychiatrist, testified he was treating M.B., and he diagnosed 

her with “a psychotic disorder not otherwise specified.” N.T., 1/20/23, at 4. 

He testified M.B.’s psychotic disorder is “severe,” and she is “severely mentally 

disabled.” Id. Dr. Wright indicated he was seeking additional inpatient 

____________________________________________

2 M.B. was present and represented by counsel during the hearing. 
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treatment for M.B. Id. at 5. Specifically, the following relevant exchange 

occurred during the direct examination of Dr. Wright by DHS’s counsel:

Q. And, doctor, what is causing you to seek additional inpatient 

treatment today?

A. She has persistent symptoms. She was admitted on an 

involuntary commitment due to dilutional—paranoid thoughts 

formal thought disorder specifically disjointed into logical thoughts 

and aggression.

She was aggressive toward her daughter, who was the 

petitioner. She has persistent symptoms. It’s my concern if she 

were released at this time there would be a reoccurrence of 

dangerous behavior.

Q. And, doctor, what persistent symptoms have you observed or 

your staff?

A. She has not been aggressive in the hospital. She has been 

intrusive with staff and with other patients. She has continued 

paranoid thoughts and continued formal thought disorder. As I 

mentioned, [she has] disorganized, illogical, disjointed thoughts.

***

Q. Doctor, how is the patient responding to treatment or 

medication?

A. She has been compliant with medication, but I would say 

there’s still disorder in that she’s very disjointed.

It’s very hard to follow her stream of thought. She seems 

to be a little less suspicious; although, there’s still an element of 

some suspiciousness and paranoia. So, she may be—to answer 

your question slightly better but still very symptomatic.

Q. And, doctor, if additional treatment is authorized, what would 

you need to see from [M.B.] to be able to discharge her safely?

A. Well, compliance. As I mentioned, she has been compliant but 

only reluctantly so. So, I would like to see improved insight so 

that I feel confident she will comply with medication outside of the 

hospital, and I would like to see an improvement in the psychotic 

symptoms. 

Id. at 5-6. 
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Dr. Wright opined that additional inpatient treatment was the least 

restrictive treatment option. Id. at 7. He testified M.B. does not have “insight 

into her psychiatric illness,” and, thus, she does not “understand that she has 

a problem[.]” Id. He opined that, absent inpatient treatment, M.B. would 

have a “persistence of her symptoms and a risk of reoccurring dangerous 

behaviors.” Id. He noted he was committed to discharging M.B. as soon as 

it was safe to do so. Id. 

On cross-examination, Dr. Wright explained that M.B. is so intrusive that 

it is “very difficult to disengage from her.” Id. at 8. She demands immediate 

attention, and when she is given attention, it is very hard for staff and other 

patients to “disengage from that interaction.” Id. Dr. Wright admitted that 

M.B. had not been aggressive in the hospital towards staff or patients; 

however, she did “barricade her daughter in the room” on an occasion. Id. 

Dr. Wright explained that M.B.’s thoughts are neither logical nor goal 

directed. Id. She can’t get “from Point A to Point B” in any logical manner. 

Id. Dr. Wright reaffirmed that inpatient treatment in the hospital was the 

least restrictive option for M.B. to have her mental health needs met. Id. at 

9. He opined she does not presently have the insight needed to comply with 

her medication, and although she was not aggressive while in the “controlled 

and protected environment” of the hospital, she was aggressive when she was 

not committed to the hospital. Id. at 9-10. Dr. Wright specifically opined 

that, within a reasonable degree of medical certainty, in “[his] professional 
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opinion there would be a reoccurrence of the dangerous behavior” if M.B. were 

released from inpatient treatment at that time. Id. at 10.

On redirect examination, Dr. Wright testified that, on one occasion 

during the initial emergency twenty-day involuntary commitment, M.B.

barricaded her daughter in a hospital room and would not allow her to leave. 

Id. at 11-12. It took “coercion” by the staff to convince M.B. to unlock the 

door. Id. at 12. 

M.B. testified she would like to be discharged from involuntary 

commitment. Id. at 14. She testified (verbatim):

I do not have any passive aggressiveness. I did not hold 

my daughter in the room. I’m a Christian, and I was telling her 

that her holy spirit man is when you put on your armor of God. 

She gets a little anxious, and she gets very upset. 

I did not have any past things at my house. I just had no 

electric, and I had to make sure that everything was okay. If you 

have no electric, you’re not sure what will happen. So, I had to 

keep—make sure that my house was secure, and I spoke with my 

group therapist, and we both agreed about no procrastination—do 

not procrastinate, you know, that I was ready to go home.

I know how to set my goals straight in the right path. I’m 

assured that I will be fine. I’ve made my way all my life in the 

right direction. I’ve never had any mental disorders. It was just 

due to a lot of COVID-19 and a lot of people that were changing 

their direction because of flooding and disasters that went through 

the town from 2018 to 2021, and I had a lot that I had to, you 

know, set forth and take care of.

It's always depending upon the situation of where, you 

know, things go on. And I believe a lot of things with the hospital 

here—when I came a lot did not know of my situation. I came on 

very strongly, and a lot of that was due to that. I know that I will 

be fine, and I love my daughter very much and would never hold 

her down or hurt her. I raised her right.
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I took care of a three-bedroom house on my own, took care 

of my parents since 1995....I know how to make my way and take 

care of myself. As I was quoting to you, I love my daughter very 

much and would never harm her, and I don’t persist on my own 

way. I just take care of myself, and you do good onto others. But 

you stay out of other’s business, and I just do what I have to do 

for myself. And I wish no bad on no one.

But I have the wisdom, insight, and good discernment how 

to take care of myself, and the right directive path and how to put

things---set forth a schedule for myself.

And the medication I, you know, believe that it was fine 

when it was the lower—we had lowered the medicine, and it was 

absolutely fine with me before I was not on any medicine. I have 

no suspicion of nobody. I’m not paranoid.

There is a lot of things in my family line that a lot of—just 

the aggressiveness, just a lot of things that—the old school way 

that I, you know, grew up with. But I do not plug in—I plug into 

taking care of myself in the right directive path, and I truly believe 

that I would be fine going home.

***

I’m a Christian. I’m a Christian. I believe in the mighty

kingdom of God, and I raised my daughter---

Id. at 14-16. 

At the conclusion of the hearing, MHRO Price dismissed the petition, and

on January 20, 2023, DHS filed a petition for review with the orphans’ court. 

On January 23, 2023, the orphans’ court held a hearing, during which the 

recording from the January 20, 2023, hearing was played for the orphans’ 

court. 

By order filed on January 23, 2023, the orphans’ court reversed the 

dismissal issued by MHRO Price and ordered the involuntary commitment of 

M.B. to the St. Clair Memorial Hospital for inpatient treatment pursuant to 
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Section 7304 of the MHPA for a maximum of ninety days beginning on January 

20, 2023. This timely, counseled appeal followed,

3 and all Pa.R.A.P. 1925 

requirements have been met.

On appeal, M.B. sets forth the following issue in her “Statement of 

Questions Presented” (verbatim):

1. Did the orphans’ court err in reversing the decision of the 

Mental Health Review Officer (MHRO), who did not find that 

M.B. was a danger to herself or to others and denied the 

request for additional commitment pursuant to Section 7304 of 

the Mental Health Procedures Act?

M.B.’s Brief at 4 (suggested answer omitted).

On appeal, M.B. contends the orphans’ court erred in reversing the order 

of MHRO Price and directing that she be involuntarily committed for inpatient 

treatment pursuant to Section 7304 of the MHPA for an additional period not 

to exceed ninety days. Specifically, M.B. contends the evidence was 

insufficient to justify her continued involuntary commitment under Section 

7304 since “there was no evidence presented at the review hearing that M.B. 

is a clear and present danger to herself or to others.” M.B.’s Brief at 18 (italics 

omitted). M.B.’s position is that, while some of her behavior “may be annoying 

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3 Although M.B.’s ninety-day commitment order has expired, this matter is 

not moot. See Commonwealth v. C.B., 452 A.2d 1372, 1373 (Pa.Super. 

1982) (stating that because an “order of involuntary commitment affects an 

important liberty interest, and because by their nature most involuntary 

commitment orders expire before appellate review is possible, [an appeal 

therefrom] is not moot.”).
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or irritating to the person conversing with [her],” it did not rise to the level of 

a clear and present danger to herself or others, which the MHPA requires in 

order to justify continued involuntary commitment. M.B.’s Brief at 25.

This Court reviews determinations pursuant to the MHPA to “determine 

whether there is evidence in the record to justify the [orphans’] court’s

findings.” In re S.M., 176 A.3d 927, 935 (Pa.Super. 2017) (citation omitted). 

“Although we must accept the [orphans’] court’s findings of fact that have 

support in the record, we are not bound by its legal conclusions from those 

facts.” Id.

We briefly summarize the MHPA:

The MHPA provides for involuntary emergency examination and 

treatment of persons who are “severally mentally disabled and in 

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.

In re S.M., 176 A.3d at 930-31 (some citations omitted and formatting 

altered).

Section 7301(a) describes the circumstances under which a mentally 

disabled person may be subject to involuntary treatment:

Whenever a person is severely mentally disabled and in need of 

immediate treatment, [she] may be made subject to involuntary 

emergency examination and treatment. A person is severely 

mentally disabled when, as a result of mental illness, [her]
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capacity to exercise self-control, judgment and discretion in the 

conduct of [her] affairs and social relations or to care for [her]

own personal needs is so lessened that [she] poses a clear and 

present danger of harm to others or to [herself], as defined in [50 

P.S. § 7301(b)].

50 P.S. § 7301(a).

Relevantly, 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 herself, 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 [herself] shall be shown by 

establishing that within the past 30 days:

(i) the person has acted in such manner as to evidence that 

[she] would be unable, without care, supervision and the 

continued assistance of others, to satisfy [her] need for 

nourishment, 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. 50 P.S. § 7304(g). Section 7304(a)(2) states the criteria for 

involuntary treatment of a person that is already 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 [her] condition 
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continues to evidence a clear and present danger to [herself] 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.

50 P.S. § 7304(a)(2). 

In In re S.M., supra, this Court clarified Section 7304(a)(2) as follows:

[T]he petitioner need not relitigate the initial commitment 

and....the [orphans’] 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.

In re S.M., 176 A.3d at 936 (citations omitted and formatting altered).

In sum, under Section 7304(a)(2), a 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 herself or others,

“in fact occurred.” See 50 P.S. §§ 7301(b)(1)-(2), 7304(a)(2). Second, the 

petitioner must establish the patient’s condition continues to evidence a clear 

and present danger to herself or others. 50 P.S. § 7304(a)(2).

Regarding the first factor, in the case sub judice, M.B. specifically 

concedes there is no dispute that DHS established the first factor, i.e., her 

prior conduct, which resulted in her original commitment, qualified as a clear 

and present danger to herself or others, and it in fact occurred. See In re 

S.M., supra. That is, she concedes “there is no question that the initial 

Section 7302 petition that committed M.B. to involuntary treatment was 

properly filed and decided. Moreover, M.B. consented to the initial up-to-20
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days of confinement and treatment under Section 7303.”4 M.B.’s Brief at 13-

14. Accordingly, we proceed to examine whether DHS established the second 

factor, i.e., M.B.’s condition continues to evidence a clear and present danger 

to herself or others. See In re S.M., supra.

Here, in analyzing the second factor, the orphans’ court relevantly 

indicated the following:

Per the tape of the January 20, 2023, hearing, which was 

played in open court on January 23, 2023, Bruce Wright, M.D., 

who is [M.B.’s] treating psychiatrist, testified that [M.B.] has “a 

psychotic disorder not otherwise specified” in the “severe” range. 

N.T., 1/20/23, at 4. He stated that [M.B.] has persistent 

symptoms and that if she were released there would be a

reoccurrence of dangerous behavior. [M.B.] has continued 

paranoid thoughts and continued formal thought disorder. Her 

thoughts are “disjointed” and “illogical” (i.e., she cannot get from 

Point A to Point B, her thoughts “do not make sense”). [Id.] at

5, 8-9. While [M.B.] has been compliant with medication [during 

the time she has been committed], she is reluctant to take the 

medication, and Dr. Wright expressed his concern that she will not 

comply with the medication requirements outside the hospital 

setting. [Id.] at 6-7. In his professional opinion, within a 

reasonable degree of medical certainty, Dr. Wright further stated 

that additional inpatient treatment is the least restrictive 

treatment option because he does not believe [M.B.] has the 

____________________________________________

4

In any event, we note the record contains M.B.’s commitment history, 

including her original commitment, which was based on her severe mental 

disability. See In re S.M., supra. DHS sought the original Section 7303 civil 

commitment based on an application completed by M.B.’s adult daughter. 

Specifically, M.B.’s daughter indicated M.B. could not care for herself, could 

not pay bills, could not take care of her basic needs, could not make decisions 

for her own well-being, was violent, was paranoid, did not make sense when 

having a conversation, threw temper tantrums, and threatened to kill her 

daughter. She noted that M.B. often lived in a home with no utilities because 

she could not remember to pay the bills, would not eat because she believed 

her food had been poisoned, and believed people were following her. 
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insight into her psychiatric illness to understand that she has a 

problem [or] that she will comply with treatment by taking her 

mediation [sic] outside the hospital setting. Dr. Wright stated that 

he will discharge [M.B.] as soon as it can be done safely. [Id.] at 

7.

[M.B.] made a statement to [MHRO Price] in a rather 

rambling fashion. She stated that she loves her daughter, and 

she would not harm her. She further stated that she has “no 

suspicion of nobody,” she is not paranoid, and she “would be fine 

going home.” [Id.] at 14-16. 

Based upon [the orphans’] court’s further review of the 

transcripts, it is abundantly clear that the reversal of the dismissal 

was proper under the facts of the case....Dr. Wright testified 

without hesitation that, in his professional opinion, [M.B.] was 

likely to engage in dangerous conduct in the future due to her 

continued lack of insight into her mental illness...[and] she would 

not maintain her medication regime.

Orphans’ Court Opinion, filed 3/21/23, at 3-4 (some quotation marks 

omitted).

We conclude the orphans’ court’s factual findings are supported by the 

record, and we find no error in its legal conclusions. See In re S.M., supra. 

Here, Dr. Wright testified M.B.’s severe mental disability, for which she was 

originally committed, persists with M.B. having paranoid thoughts, disjointed 

thoughts, illogical thoughts, and formal thought disorder. He noted that, 

during the time she has been receiving inpatient treatment, her severe 

mentally disabling symptoms have become “slightly better but [she is] still 

very symptomatic.” N.T., 1/20/23, at 5. 

Dr. Wright indicated that M.B. had been “reluctantly compliant” with 

taking her medication while she was receiving inpatient treatment. Id. at 5. 

He opined that, if M.B. were immediately released from inpatient mental 
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treatment, she would not remain compliant with taking her medications 

because she does not have insight into her own psychiatric illness. Id. at 7.

However, he noted that, given further improvement in her psychotic 

symptoms, she may improve in the areas of awareness and compliance. Id. 

Further, M.B.’s own statements to MHRO Price during the January 20, 

2023, hearing confirmed Dr. Wright’s testimony that she would not remain 

compliant with taking her medications if she were discharged from inpatient 

treatment. M.B. informed MHRO Price that “it was absolutely fine with me 

before I was not on any medicine.” Id. at 16. 

Moreover, Dr. Wright opined, beyond a reasonable degree of medical 

certainty, that M.B.’s persisting symptoms made it likely her dangerous 

behaviors would reoccur if she were released from inpatient treatment. As 

indicated supra, M.B. was originally involuntarily committed, in part, because 

she evidenced a clear and present danger to herself, including being unable 

to meet her own personal, medical, or safety needs to an extent that there 

was a reasonable probability of death, serious bodily injury, or serious physical 

debilitation. See 50 P.S. § 7301(b)(2)(i). In her testimony to MHRO Price 

during the January 20, 2023, hearing, M.B. demonstrated her continued 

inability to think logically so as to meet her own personal, medical, and safety 

needs. For example, she demonstrated no recognition that the reason her 

house did not have electricity arose from her failure to pay the utility bill. 

Further, she blamed the COVID-19 pandemic, as well as “flood[s] and disaster 
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that went through the town from 2018 to 2021,” for her mental state. N.T., 

1/20/23, at 14. Also, as indicated supra, she indicated she was “fine” without 

taking her medication. Thus, the orphans’ court was justified in concluding 

DHS demonstrated M.B.’s condition continues to evidence a clear and present 

danger to herself. See 50 P.S. § 7301(b)(2)(i).

While our analysis could end at this point, we note the orphans’ court 

was also justified in concluding DHS demonstrated M.B.’s condition continues 

to evidence a clear and present danger to others. See 50 P.S. § 7301(b)(1). 

M.B. was originally involuntarily committed, in part, because she evidenced a 

clear and present danger to others, including her daughter, who she 

threatened to kill. 

During the time M.B. received inpatient medication and treatment under 

the original Section 7303 civil commitment, M.B. did not demonstrate 

aggressive behavior towards staff or other patients. However, M.B. barricaded 

herself and her daughter in a hospital room and did not unlock the door until 

being coerced by hospital staff. In her testimony to MHRO Price during the 

January 20, 2023, hearing, M.B. explained that she kept her daughter in her 

room because she wanted to tell “her that her holy spirit man is when you put 

on your armor of God.” N.T., 1/20/23, at 14. The evidence demonstrates 

that, while being medicated, M.B.’s aggressive behavior improved; however, 

due to her severe mental disability, M.B. continued to be a clear and present 

danger to at least her daughter. See 50 P.S. § 7301(b)(1). Moreover, as 
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indicated above, Dr. Wright opined that if M.B. were released from inpatient 

treatment, she would not take her medication, and her dangerous behavior, 

including her behavior towards others, would reoccur. 

Based on the record, we agree with the orphans’ court that there is 

sufficient evidence to justify its findings that M.B’s condition continued to 

evidence a clear and present danger to herself and others. See In re S.M., 

supra. Therefore, we affirm the order extending M.B.’s commitment pursuant 

to Section 7304.

Affirmed. 

Date: 10/20/2023