Court Opinion

ID: 9378480
Source: CourtListenerOpinion
Date Created: 2023-03-10 17:08:16.715582+00
Date Added: 2024-06-11T17:17:21.548051
License: Public Domain

J-A14017-22, J-A14018-22

                           2023 PA SUPER 38

STEVEN MATOS, INDIVIDUALLY AND AS             IN THE SUPERIOR COURT
ADMINISTRATOR OF THE ESTATE OF                   OF PENNSYLVANIA
JESSICA L. FREDERICK, DECEASED

                 v.

GEISINGER MEDICAL CENTER; MICHAEL
H. FITZPATRICK, MD; RICHARD T.
DAVIES, JR., PA-C; ALLEY MEDICAL
CENTER; DAVID Y. GO, M.D., AND KYLE
C. MAZA, PA-C

APPEAL OF: ALLEY MEDICAL CENTER;
DAVID Y. GO, M.D.; AND KYLE C. MAZA,
PA-C

                                                No. 1189 MDA 2021

             Appeal from the Order Entered June 15, 2021
           In the Court of Common Pleas of Columbia County
                   Civil Division at No: 1067-CV-2013

STEVEN MATOS, INDIVIDUALLY AND AS             IN THE SUPERIOR COURT OF
ADMINISTRATOR OF THE ESTATE OF                      PENNSYLVANIA
JESSICA L. FREDERICK, DECEASED

                  v.

GEISINGER MEDICAL CENTER; MICHAEL
H. FITZPATRICK, MD; RICHARD T.
DAVIES, JR., PA-C; ALLEY MEDICAL
CENTER; DAVID Y. GO, M.D., AND KYLE
C. MAZA, PA-C

APPEAL OF: GEISINGER MEDICAL
CENTER; MICHAEL H. FITZPATRICK, MD;
AND RICHARD T. DAVIES, JR. PA-C                  No. 1190 MDA 2021
J-A14017-22, J-A14018-22

                  Appeal from the Order Entered June 15, 2021
                In the Court of Common Pleas of Columbia County
                        Civil Division at No: 1067-CV-2013

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

OPINION BY STABILE, J.:                          FILED: MARCH 10, 2023

         In these interlocutory appeals by permission, which we consolidate

under Pa.R.A.P. 513, Appellants, Geisinger Medical Center, Alley Medical

Center, and individuals employed by these entities,1 seek review of the trial

court’s refusal to grant them summary judgment in an action brought by

Appellee, Stephen Matos, administrator of the estate of Jessica Frederick,

deceased, under the Mental Health Procedures Act (“MHPA”), 50 P.S. §§

7101—7503. The record demonstrates that Westley Wise (“Wise”), who had

a record of acute psychiatric issues, submitted himself for voluntary inpatient

examination and treatment by presenting himself at Geisinger and then at

Alley.    Medical personnel at both facilities examined Wise but denied his

requests for treatment.2 Wise murdered his girlfriend, Frederick, the same

day that Alley refused treatment. Matos alleges that Geisinger and Alley are
____________________________________________

*   Former Justice specially assigned to the Superior Court.

1We will refer to Geisinger and its personnel collectively as “Geisinger” and to
Alley and its personnel collectively as “Alley.” We will refer to Appellee as
“Matos.”

2 We acknowledge that both Geisinger and Alley have at times challenged
whether they in fact examined Wise. For purposes of reviewing this denial of
summary judgment, we will accept the fact that both examined Wise as pled
by Matos, the non-moving party.

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liable for gross negligence and/or willful misconduct because they denied

Wise’s request for treatment. Relying on Leight v. University of Pittsburgh

Physicians, 243 A.3d 126 (Pa. 2020), a decision that addressed the

involuntary examination process under the MHPA, Geisinger and Alley contend

they are not liable under the MHPA because no written application was ever

made to admit Wise for voluntary inpatient treatment.     We disagree.    The

prerequisites to triggering application of the MHPA are not the same for

involuntary examination, the process analyzed in Leight, and voluntary

inpatient treatment, the process in this case.   While the MHPA requires a

written application to begin the involuntary examination process, it does not

require a written application to begin voluntary inpatient examination and

treatment. Thus, facilities such as Geisinger and Alley may be held liable for

refusal to provide voluntary inpatient examination and treatment to a person

who submits himself for examination and treatment when the refusal

constitutes willful misconduct or gross negligence. Accordingly, we affirm the

denial of summary judgment and remand for further proceedings.

      The evidence, construed in the light most favorable to Matos,

demonstrates that Wise suffered a traumatic brain injury at the age of six

when he was thrown from the back of an ATV while riding without a helmet.

He was in a coma at Geisinger for days but eventually regained consciousness

and then required extensive hospitalization thereafter. The accident left Wise

with ongoing cognitive and behavioral issues throughout his childhood and

adolescence, including poor judgment and lack of impulse control.

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      In May 2000, Wise was heavily abusing alcohol and street drugs and

had acute psychological problems.      He checked himself into Geisinger for

psychiatric treatment and was placed into an inpatient treatment center for

what he described as a nervous breakdown. He was released after 28 days

of treatment.

      Between 2005 and 2007, Wise treated with Alley for mental health

issues, including bipolar disorder. In 2007, while living with Jennifer Karns,

the mother of two of his children, Wise again abused drugs and alcohol and

had significant employment issues. During an argument with Jennifer, Wise

“blacked out” and “snapped,” R.R. 565, and cut Jennifer’s throat with a knife.

Wise was convicted of simple assault and served 21 months in county jail.

      In January 2011, Wise again was using street drugs and was having

employment problems and ongoing problems with his live-in girlfriend, Jessica

Frederick.   In addition, his best friend died in a drunk driving automobile

accident. On January 21, 2011, Wise reacted to these events by calling for

an ambulance to take him to Geisinger’s emergency room. Wise testified that

he went to Geisinger because he previously had been admitted there for

voluntary psychiatric treatment and was familiar with its admission process.

Wise’s father received a call that night that Wise was going to the hospital for

psychiatric treatment. Wise’s father drove from Pottstown to Geisinger to be

with Wise.

      Wise submitted himself for examination and requested inpatient

treatment, stating to Geisinger personnel that he was “suicidal, like I was

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going to snap,” Wise Deposition at 64, that he felt “suicidal or homicidal,” id.

at 65, and that he “felt like I was going to snap. I didn’t feel mentally right

at the time.”    Id.   Wise recounted his conversation with the psychiatric

physician assistant, Appellant Davies, as follows:

      Q. What did you tell him?

      A. Just told I felt like I was going to snap. I told him I wasn’t
      mentally right, that I wanted to stay there.

      Q. You asked him to stay there?

      A. Yeah.

      Q. Why did you want to stay there?

      A. I just wasn’t feeling safe, wasn’t feeling okay.

      Q. And how long were you with this . . . physician[] assistant, Mr.
      Davies?

      A. Maybe 15, 20 minutes.

      Q. Did you ask him if you could stay at the hospital?

      A. Yeah.

      Q. What did he say?

      A. He said no.

      Q. Did he explain to you why?

      A. Basically he was saying I wasn’t bad enough to stay there, more
      or less.

Id. at 69.

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      Geisinger discharged Wise without admitting him as an inpatient and

without administering any treatment.        According to Geisinger’s medical

records, the plan for Wise merely advised him to stop alcohol and street drugs,

take daily vitamins, contact the area Service Unit for psychiatrist supervision

and call Tapline if he was suicidal or homicidal or felt worse.

      Wise’s father, Barry, informed Geisinger that Wise stated he feared he

would harm himself or another person:

      Q. Okay. What did you observe during this interaction?

      A. Well, . . . he introduced himself. And I don’t know what his
      name was . . . I don’t know.

      Q. Okay.

      A. [] I asked him, . . . what was going on. And I said, I know he
      . . . when I come there, too, I had asked Wes, too. And he said,
      I need to stay here. I need to stay here, you know. And I asked
      him, I said . . . he wants to be committed and stuff. And he says,
      well, he’s not bad enough. And I says, what do you mean, not
      bad enough? . . . I said, if a person . . . calls 911 and come here
      because . . . they are afraid of doing something or hurting
      themselves or somebody, I mean - - and they said, well, you
      know, we don’t feel he’s bad enough....

Barry Wise Deposition at 86.

      On January 24, 2011, three days after his discharge from Geisinger,

Wise, accompanied by his father, presented for examination and inpatient

treatment at Alley.   Wise’s father told physician assistant Maza that Wise

needed help because he feared hurting himself or someone else, “And you

know, I said, you know, I think he needs to be put somewhere so . . . he

needs help. Some help.” Id. at 110. Wise’s father elaborated:

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      Q. Okay. Did you tell ... Mr. Maza ... that you believed that Wes
      was either a danger to himself or someone else?

      A. I said - - this is what I remember saying when we sat there:
      You know, I told him about the Geisinger thing. You know, he
      called to get help, you know, because he felt he was going to hurt
      himself or somebody....

Id. at 113. Wise testified that he told Maza he had been having hallucinations

and delusions, that he was suicidal or homicidal, and that he felt as if he were

going to snap. Wise Deposition at 81-83. Nevertheless, Alley discharged Wise

without further treatment.

      Wise returned home to his apartment, where his girlfriend, Jessica

Frederick, asked him to stay the night because he was planning to go to his

father’s residence for the foreseeable future. Wise killed Frederick that night

and attempted unsuccessfully to kill himself. Wise later pled guilty to third-

degree murder and is now serving a sentence of imprisonment.

      Matos, the administrator of Frederick’s estate, commenced this action

alleging that Geisinger and Alley are liable under the MHPA for gross

negligence and/or willful misconduct in failing to diagnose Wise’s condition

and failing to initiate inpatient treatment. In mid-2017, Geisinger and Alley

each filed motions for summary judgment, claiming, inter alia, that they did

not owe any duty of care to Frederick under the MHPA. In late 2017, the trial

court denied these motions, and in early 2018, the court denied Geisinger’s

and Alley’s motions for reconsideration.

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        In April 2019, Geisinger and Alley each filed their second motions for

summary judgment, citing the Superior Court’s decision in Leight3 that

medical providers were not liable under the MHPA for refusing to initiate

involuntary commitment procedures against a patient who subsequently killed

one person and injured several others in a shooting spree. One month later,

the trial court denied Geisinger’s and Alley’s motions.

        On June 1, 2021, Geisinger and Alley each filed their third motions for

summary judgment based on our Supreme Court’s decision in Leight

affirming this Court’s decision that the medical providers were not liable under

the MHPA. On June 15, 2021, the trial court denied Geisinger’s and Alley’s

motions but granted them permission to take an immediate interlocutory

appeal to this Court. Geisinger and Alley filed timely petitions for permission

to appeal, and this Court granted both petitions.

        Alley raises one issue in its appeal:

        Whether [Matos] has a viable cause of action under section 7114
        of the Mental Health Procedures Act, when in [Leight], the
        Supreme Court expressly limited liability under the Act to
        decisions made after treatment had been formally initiated under
        the act, which circumstances did not occur in the instant matter?

Alley’s Brief at 9.

        Geisinger raises two issues in its appeal:

        (1) Whether the precedents established by the Supreme Court of
        Pennsylvania in Goryeb v. Commonwealth Dept. of Public
        Welfare, 575 A.2d 545 (Pa. 1990) and [Leight], which arise in
____________________________________________

3   202 A.3d 103 (Pa. Super. 2018).

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      the context of involuntary examination and treatment under
      Article III of the MHPA, apply with equal force to voluntary
      examination and treatment under Article II of the Act?

      (2) Whether the Supreme Court of Pennsylvania’s precedent in
      Leight—which declined to extend a statutory duty to control a
      patient for the protection of a third party absent formalization of
      the statutory prerequisites necessary to initiate an examination
      under the Act—mandates dismissal of this action when the
      uncontroverted record establishes that the patient was never
      treated under the dictates of the MHPA?

Geisinger’s Brief at 3-4.

      Our standard of review of an order granting or denying summary

judgment is well-settled:

      We view the record in the light most favorable to the nonmoving
      party, and all doubts as to the existence of a genuine issue of
      material fact must be resolved against the moving party. Only
      where there is no genuine issue as to any material fact and it is
      clear that the moving party is entitled to a judgment as a matter
      of law will summary judgment be entered. Our scope of review of
      a trial court’s order granting or denying summary judgment is
      plenary, and our standard of review is clear: the trial court’s order
      will be reversed only where it is established that the court
      committed an error of law or abused its discretion.

Daley v. A.W. Chesterton, Inc., 37 A.3d 1175, 1179 (Pa. 2012).

      Geisinger’s and Alley’s arguments boil down to a few simple points in

support of their argument that they are immune from liability under Section

114(a) of the MHPA, 50 P.S. § 7114(a). Geisinger argues that under Leight

the prerequisites for voluntary inpatient treatment were not met to trigger the

MHPA, since Wise never filled out an application to commence the process for

voluntary inpatient treatment. Geisinger Brief at pgs. 9-10. Similarly, Alley

argues that the MHPA’s plain language does not apply to a physician’s

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decision-making regarding whether to commit an individual for voluntary

inpatient treatment, and that under Leight, the MHPA does not apply where

commitment is considered but not formalized with a written certification or

application by a physician, among other requirements. Alley Brief at pgs. 10-

11.

      Section 7114(a) provides:

       (a) In the absence of willful misconduct or gross
       negligence, a county administrator, a director of a facility, a
       physician, a peace officer or any other authorized person who
       participates in a decision that a person be examined or treated
       under this act, or that a person be discharged, or placed under
       partial hospitalization, outpatient care or leave of absence, or that
       the restraint upon such person be otherwise reduced, or a
       county administrator or other authorized person who
       denies an application for voluntary treatment or for
       involuntary emergency examination and treatment, shall not be
       civilly or criminally liable for such decision or for any of its
       consequences.

50 P.S. § 7114. (Emphasis added). “Section 7114 has been characterized as

an immunity provision, as well as providing for a statutory cause of action,

albeit by implication.” Leight, 243 A.3d at 140.

      The issue whether Geisinger and Alley are immune under Section 7114

raises a question of statutory interpretation. Id. at 139. Our overriding object

in interpreting a statute is “to ascertain and effectuate the intention of the

General Assembly” in enacting the statute.         1 Pa.C.S.A. § 1921(a).      If

statutory language is “clear and free from all ambiguity, the letter of it is not

to be disregarded under the pretext of pursuing its spirit.” Id., § 1921(b).

When the words of a statute have a plain and unambiguous meaning, it is this

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meaning which is the paramount indicator of legislative intent. Leight, 242

A.3d at 139.

      In Leight, our Supreme Court, applying statutory construction

principles, addressed whether health care professionals could be liable under

Section 7114 for failure to initiate the application process for an involuntary

emergency examination at a mental health facility.      The trial court and all

parties in the present case argue that Leight supports their respective

positions as to whether Geisinger and Alley properly denied voluntary inpatient

treatment to Wise. Accordingly, we begin with a detailed discussion of Leight

before performing further statutory analysis of Section 7114.

      In Leight, the Court considered the viability of an action under the

MHPA against medical providers who considered, but did not initiate, an

involuntary emergency examination under Section 302 of the MHPA, 50 P.S.

§ 7302, against an outpatient named Shick. The plaintiffs alleged that Shick

had a six-year history of mental instability and psychiatric care for depression

and bipolar disorder.    He had been involuntarily committed on several

occasions but then released.        His outpatient primary care physicians

encouraged him to treat with a psychiatrist, but he repeatedly declined

medication and treatment and became schizophrenic and noncompliant with

his medications. One of his primary care physicians requested paperwork to

begin proceedings to determine if he should be involuntarily committed, but

the physician failed to complete the process. One week after the doctor failed

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to file the paperwork, Shick was sent a letter advising that the practice would

no longer provide care to him. Eight days later, Shick went to a psychiatric

clinic with two loaded firearms and opened fire, killing one person and injuring

several others, including the receptionist. The receptionist and her husband

filed a civil complaint against the primary care physicians, asserting that the

physicians should have begun an involuntary emergency examination under

the MHPA. The trial court sustained the defendants’ preliminary objections to

the MHPA claim and dismissed it for failure to state a cause of action. This

Court affirmed the dismissal of the MHPA claim.

       Our Supreme Court accepted the plaintiffs’ petition for allowance of

appeal and ultimately held that the complaint failed to state a cause of action

under the MHPA.         The Court began by acknowledging that the General

Assembly’s purpose for enacting the MHPA in 1976 was to assure the

availability of adequate treatment to those who are mentally ill. Leight, 243

A.3d at 130 (citing 50 P.S. § 7102). The legislature, through the MHPA, and

in conformity with principles of due process, sought to assure the availability

of voluntary and involuntary treatment “where the need is great and its

absence could result in serious harm to the mentally ill person or to others.”

Id.   The plain language of Section 103 of the MHPA, 50 P.S. § 7103,4 makes

____________________________________________

4 50 P.S. § 7103 provides, “This act 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.”

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clear that the MHPA does not extend to voluntary outpatients; it applies “only

to inpatients and involuntary outpatients.” Leight, 243 A.3d at 139. Because

there was no suggestion that the physicians treated Shick on anything but a

voluntary outpatient basis, the Court concluded that the physicians’ treatment

actions fell outside the coverage of the MHPA.

      The plaintiffs argued that the physicians participated in a treatment

decision, and therefore were liable under the MHPA, because they began (but

did not complete) the statutory process for involuntary commitment.          The

Court rejected this argument based on its construction of Sections 7114 and

7302. Section 7114, the Court observed, immunizes individuals from liability

who, inter alia, “participate[] in a decision that a person be examined or

treated under [the MHPA],” except in instances of willful misconduct or gross

negligence. Under Section 302, a person can be subjected to an involuntary

emergency examination only if one of three mandatory prerequisites is met:

(1) certification of a physician; (2) warrant issued by the county administrator

authorizing such examination; or (3) application by a physician or other

authorized person who has personally observed actions indicating a need for

an emergency application.     Reading Sections 7114 and 7302 together, the

Court concluded that the providers did not “participate” in a decision that Shick

be examined, and therefore were immune from liability, because none of the

three preconditions under Section 302 were met:

      ‘[P]articipat[ing] in a decision that a person be examined’ under
      the MHPA is achieved for purposes of Section [7114] only after

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     one of the prerequisites set forth in Section [7302] for an
     involuntary emergency examination is satisfied.               The
     requirements of Section [7302] are exclusive, clear, and
     unequivocal.    Physicians who never invoke a necessary
     requirement for involuntary emergency examination are not, for
     purposes of Section [7114], participating in a decision that a
     person be examined. It is only when a physician files the required
     documentation for involuntary emergency examination that he
     becomes a participant in the decision-making process under the
     Act.

     In addition to the manifest requirements of Section [7302], this
     conclusion is supported by the later phrase in Section [7114]
     which grants immunity to those “who den[y] an application for
     voluntary treatment or for involuntary emergency examination
     and treatment.” 50 P.S. § 7114. Clearly, an application cannot
     be denied until it is first formally made.

     Actions by a physician in an outpatient setting that fall short of
     satisfying these mandatory requirements do not transform
     voluntary outpatient treatment into involuntary treatment.

Id. at 141 (emphasis added). The Court concluded:

     Applying our interpretation of the MHPA’s provisions to the instant
     case, we find that Appellees’ physicians never satisfied the
     prerequisites for the involuntary emergency examination process
     under Section [7302] for Shick.        That being the case, the
     physicians did not take part in a decision that Shick be examined
     or treated under Section [7114], and, therefore, they were not
     engaged in an involuntary commitment decision. We reiterate
     that mere thoughts, consideration, or steps short of the mandated
     Section [7302] prerequisites for initiating an involuntary
     emergency examination lie outside of a Section [7114] cause of
     action. As Appellees and their physicians never participated in a
     ‘decision that a person be examined or treated under the [MHPA],’
     we are compelled to conclude that Section [7114] is inapplicable
     and Appellants’ cause of action was rightfully dismissed.

Id. at 143.

     Central to Leight’s conclusion that the physicians were immune from

liability under Section 7114 was its determination that the physicians did not

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satisfy any prerequisite for an involuntary examination. Geisinger and Alley

argue that there is no reason why Leight’s logic should not apply here with

equal force to cases concerning voluntary inpatient treatment. As stated, they

claim no prerequisite for voluntary inpatient treatment occurred because there

was no written application to provide voluntary inpatient treatment to Wise.

We agree that Leight’s logic applies with equal force to this case, but we

reach a different result because the prerequisites for involuntary examination

are not the same as those for voluntary inpatient examination and treatment.

We arrive at this determination by comparing the relevant statutes in the

MHPA relating to its inpatient voluntary and involuntary provisions.

   VOLUNTARY INPATIENTS                     INVOLUNTARY INPATIENTS
50 P.S. § 7201. Persons who             50 P.S. § 7301. Persons who
may authorize voluntary                 may be subject to involuntary
treatment                               emergency examination and
                                        treatment

Any person 14 years of age or           (a) Persons Subject.--Whenever a
over who believes that he is in         person is severely mentally disabled
need       of     treatment      and    and in need of immediate treatment,
substantially understands the nature    he may be made subject to
of voluntary treatment may submit       involuntary              emergency
himself to examination and              examination and treatment. A
treatment under this act, provided      person is severely mentally disabled
that the decision to do so is made      when, as a result of mental illness,
voluntarily. A parent, guardian, or     his capacity to exercise self-control,
person standing in loco parentis to a   judgment and discretion in the
child less than 14 years of age may     conduct of his affairs and social
subject such child to examination       relations or to care for his own
and treatment under this act, and in    personal needs is so lessened that he
so doing shall be deemed to be acting   poses a clear and present danger of
for the child. Except as otherwise      harm to others or to himself, as
authorized in this act, all of the      defined in subsection (b), or the
provisions of this act governing        person is determined to be in need of

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examination   and   treatment   shall assisted outpatient treatment       as
apply.                                defined in subsection (c).

50 P.S. § 7202. To              whom 50 P.S. § 7302. Involuntary
application may be made                 emergency examination and
                                        treatment authorized by a
                                        physician--Not to exceed 120
Application        for      voluntary hours
examination and treatment shall
be made to an approved facility (a) Application for Examination.--
or to the county administrator, Emergency examination may be
Veterans Administration or other undertaken at a treatment facility
agency of the          United States upon the certification of a physician
operating a facility for the care and stating     the     need    for    such
treatment of mental illness. When examination; or upon a warrant
application is made to the county issued by the county administrator
administrator, he shall designate the authorizing such examination; or
approved facility for examination and without a warrant upon application
for such treatment as may be by a physician or other authorized
appropriate.                            person who has personally observed
                                        conduct showing the need for such
50 P.S. § 7203. Explanation and examination.
consent.
                                        1)    Warrant      for    Emergency
Before a person is accepted for Examination.--             Upon       written
voluntary inpatient treatment, an application by a physician or
explanation shall be made to him other responsible party setting
of such treatment, including the forth facts constituting reasonable
types of treatment in which he grounds to believe a person is
may be involved, and any severely mentally disabled and in
restraints or restrictions to which need of immediate treatment, the
he may be subject, together with county administrator may issue a
a statement of his rights under warrant            requiring     a     person
this act. Consent shall be given authorized by him, or any peace
in writing upon a form adopted officer, to take such person to the
by the department. The consent facility specified in the warrant.
shall     include     the     following
representations: That the person (2) Emergency Examination Without
understands his treatment will a             Warrant.--     Upon     personal
involve inpatient status; that he is observation of the conduct of a
willing to be admitted to a designated person     constituting    reasonable
facility for the purpose of such grounds to believe that he is severely
examination and treatment; and that mentally disabled and in need of
he consents to such admission immediate                 treatment,      an[y]

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voluntarily, without coercion or             physician or peace officer, or anyone
duress; and, if applicable, that he has      authorized      by     the     county
voluntarily agreed to remain in              administrator may take such person
treatment for a specified period of no       to an approved facility for an
longer than 72 hours after having            emergency      examination.     Upon
given written notice of his intent to        arrival, he shall make a written
withdraw from treatment.            The      statement setting forth the
consent shall be part of the person’s        grounds for believing the person
record.                                      to   be     in    need     of    such
                                             examination.

[Emphasis added].

      As can be seen, whereas a written application is a prerequisite to

initiating the involuntary inpatient examination process, no such prerequisite

exists to commence voluntary inpatient examination and treatment.

      An involuntary inpatient examination is not the patient’s own choice; he

“is made subject to” examination, 50 P.S. § 7301, when a third person such

as a physician requests examination and treatment, 50 P.S. § 7302.             The

applicant is a third person such as a physician, peace officer or other

responsible party.    See 50 P.S. § 7302(1) (physician or other responsible

party must file a “written application” for emergency examination); 50 P.S. §

7302(2) (physician, peace officer or person authorized by the county

administrator must file a “written statement” articulating the grounds for an

emergency examination).         Under the involuntary inpatient examination

provisions medical providers are deemed immune from liability until “written”

application   is   filed   requesting   an    involuntary   emergency     inpatient

examination, as a written application is the prerequisite to initiating this

process. Leight, 243 A.3d at 141. Only after a written application is made

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may a medical provider be liable for denying an involuntary inpatient

examination if denial constitutes willful misconduct or gross negligence. Id.

       In contrast, in the case of voluntary inpatient examination and

treatment under Section 201, 50 P.S. § 7201, entitled ”[p]ersons who may

authorize voluntary treatment”, a person may submit himself for voluntary

inpatient examination and treatment. A person typically does so by taking

himself to an emergency room for an evaluation to determine the level of

treatment needed. There are no hearings required for admission. Voluntary

admission to a facility may occur after the person is examined and the

evaluating    provider     and   person        agree   that   he    would   benefit   from

hospitalization. If the person is to be admitted, he is then required to sign a

consent form that documents his rights and describes the proposed inpatient

treatment plan. In short, the prerequisite for triggering voluntary inpatient

examination and treatment is when a person “submit[s] himself” to a facility

requesting examination for inpatient treatment.5                   Thus, while we apply

Leight’s rationale that a prerequisite to treatment under the MHPA first be

satisfied before liability may be asserted against a provider under the MHPA,

the prerequisites are different for involuntary inpatient examination and

voluntary inpatient examination and treatment.                     The only prerequisite

____________________________________________

5 We acknowledge that under Section 202, 50 P.S. § 7202, a person also may
apply to a county administrator or approved agency for voluntary examination
and treatment, a process not relevant to the facts of this case because Wise
presented himself to the Geisinger and Alley facilities seeking voluntary
inpatient examination and treatment.

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necessary to trigger the MHPA’s process for voluntary inpatient examination

and treatment is a person submitting himself to an approved facility

requesting examination and admission for inpatient treatment. Nowhere does

the MHPA require that a written application first be made before the person

submits himself to a facility for examination and treatment.          While the

involuntary inpatient examination provisions require a “written” application for

examination and treatment, the term “written” is conspicuously absent from

the MHPA’s voluntary inpatient examination and treatment provisions. The

inclusion of “written” in the involuntary inpatient examination provisions and

its omission from the voluntary inpatient examination and treatment

provisions demonstrates that the legislature did not intend to require written

applications for voluntary inpatient examination and treatment. See Fonner

v. Shandon, Inc., 724 A.2d 903, 907 (Pa. 1999) (where “unless” language

was in one section of Workers’ Compensation Act but not in second section,

legislature had different intent in drafting second section; “where a section of

a statute contains a given provision, the omission of such a provision from a

similar section is significant to show a different legislative intent”). Because

of this difference, the point at which liability may attach under the MHPA

differs as between the involuntary examination and voluntary inpatient

examination and treatment processes.          If a facility refuses to examine a

person who presents himself for voluntary inpatient examination and

treatment, or after examination refuses to admit the person for treatment,

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J-A14017-22, J-A14018-22

liability may attach if the refusal constitutes willful misconduct or gross

negligence.

      The record here reflects that Wise, an individual with a history of acute

psychological problems and a criminal record for assault, visited Geisinger and

verbally requested inpatient treatment, claiming that he was homicidal and

suicidal and about to snap. Geisinger’s medical providers performed an initial

evaluation examination on Wise but declined his request for inpatient

treatment.    Three days later, Wise visited Alley and verbally requested

inpatient treatment upon the same bases.              Alley’s medical providers

performed an examination but declined Wise’s request for inpatient treatment.

That night, Wise murdered Frederick.

      Construed in the light most favorable to Matos, the trial court properly

denied summary judgment to Geisinger and Alley on the narrow question that

was before the court. A prerequisite for liability under the voluntary inpatient

examination and treatment provisions of the MHPA was satisfied when Wise

submitted himself to approved facilities, Geisinger and Alley, for voluntary

inpatient examination and treatment. Geisinger and Alley examined Wise but

denied inpatient treatment.      Under Section 7114, Geisinger and Alley

participated in decisions concerning whether to treat Wise for voluntary

inpatient treatment. Therefore, they may be subject to liability if their conduct

constituted willful misconduct or gross negligence.

      In an attempt to buttress their argument that the voluntary inpatient

examination and treatment provisions of the MHPA are not triggered until a

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J-A14017-22, J-A14018-22

written application is submitted, Geisinger and Alley cite a DHS regulation, 55

Pa. Code § 5100.72, which prescribes that “[w]ritten application for voluntary

inpatient treatment shall be made upon Form MH-781, issued by the

Department.” Id. Reference to completing such a form is found under Section

203 of the MHPA, 50 P.S. § 7203. Geisinger and Alley argue that “shall be

made” required Wise to complete a written application, and since Wise did not

do so, he never became a candidate for voluntary admission, thus shielding

Geisinger and Alley from liability. Appellants either read too much into this

provision or simply misread its purpose.     Form 781, entitled “Consent for

Voluntary Inpatient Treatment”, instructs a patient that before signing the

form, his treatment plan should be explained to him and he should be given a

copy of the Patient’s Bill of Rights. This is consistent with Section 7203. The

form then provides for the patient to execute a voluntary consent to inpatient

treatment, acknowledging that (1) he consents to the treatment that has been

explained to him, including applicable medications, examination procedures,

and restrictions, and (2) before discharge, he must give certain advance notice

in writing to those in charge of his treatment. Clearly, the regulation and its

accompanying form concern a different step in the voluntary inpatient

examination and treatment process than what is at issue in this case. The

regulation and form require the patient’s written, informed consent to

treatment after a medical provider examines him and determines that

inpatient treatment is necessary—a step that never took place in this case

because Geisinger and Alley refused to treat Wise.

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J-A14017-22, J-A14018-22

       Geisinger and Alley urge that this case will open the floodgates for

lawsuits against medical providers unless we find them immune from suit

under the MHPA. Our job, however, is to apply the law as written. It is up to

our legislature to decide policy issues as to when and under what

circumstances medical providers may be liable for harm. Here, the legislature

has drawn that line only to impose liability if the refusal to treat a person

constitutes willful misconduct or gross negligence. This demanding standard

reflects the legislature’s attempt to strike a balance between the rights of

patients and the ability of medical providers to provide adequate mental health

services.    We find our conclusion also to be consistent with the legislature’s

intent to assure the availability of adequate treatment to those who are

mentally ill and where the need is great and its absence could result in serious

harm to the mentally ill person or to others. Leight, 243 A.3d at 130 (citing

50 P.S. § 7102).

       Based on our careful review of the law, we conclude that the trial court

properly denied summary judgment to Geisinger and Alley on their claims of

immunity under the MHPA. Accordingly, we affirm the order denying summary

judgment and remand this case to the trial court for further proceedings.6
____________________________________________

6 In reaching our conclusion, we emphasize that we have decided only the
narrow question whether facilities like Geisinger and Alley may be liable for
willful misconduct or gross negligence under the MHPA for failing to admit a
person who submits himself to a facility without a written application for
voluntary inpatient examination and treatment. We offer no opinion as to
whether the evidence in this case thus far can sustain Matos’ action against
(Footnote Continued Next Page)

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       Order affirmed.        Case remanded to the trial court for further

proceedings. Jurisdiction relinquished.

Judgment Entered.

Joseph D. Seletyn, Esq.
Prothonotary

Date: 3/10/2023

____________________________________________

Geisinger and Alley where the deceased was the victim of Wise, who was
refused voluntary inpatient treatment. See Leight, 243 A.3d at 144-50
(Justice Wecht, concurring) (as to whether mental health professionals have
a duty to protect third parties from harm caused by their patients).

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