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Martin v. Holy Spirit Hospital

Superior Court of Pennsylvania

January 17, 2017


         Appeal from the Order Entered February 1, 2016, in the Court of Common Pleas of Cumberland County Civil Division at No. 13-2097



          FORD ELLIOTT, P.J.E.

         Susan M. Martin appeals from the order entered February 1, 2016, sustaining defendant/appellee's preliminary objections in the nature of a demurrer and dismissing appellant's third amended complaint with prejudice. After careful review, we reverse.

         In a prior opinion sustaining appellee's preliminary objections to appellant's first complaint, the trial court summarized the facts of this matter as follows:

The pertinent facts, viewed in the light most favorable to [appellant] as the non-moving party, can be summarized as follows: The decedent, Dawn M. Martin, had a history of mental health problems. On 17 April 2012, the decedent was brought by ambulance to [appellee] Holy Spirit Hospital's Emergency Department (ER) following a suicide attempt. The decedent sought a voluntary 201[1] commitment and, as a result of a "psych diversion" from another hospital, was transported to [appellee]'s ER. She was placed in an exam room upon arrival at 9:24 pm. While in the ER, the decedent had several encounters with hospital personnel; she voiced her suicidal intent several times during these encounters. The decedent was not seen by a physician or the crisis intervention team during her time in the ER before eloping from the hospital.
At some point during her stay in the ER, the decedent changed into a hospital gown and slippers. At approximately 10:45 pm, the decedent left her exam room. She walked past the ER charge nurse's station and the ER discharge and billing desk to get to the ER exit door; the decedent then passed through two ER exit doors and entered the ER lobby. Once in the lobby, the decedent proceeded past the ER triage nurses' station to exit the hospital through open sliding glass doors, still wearing her hospital gown and socks. At no point did any member of [appellee]'s staff intervene or question the decedent as she made her exit. The decedent subsequently walked onto the nearby U.S. Highway State Route 15 where she was struck and killed by passing motor vehicles.
The Commonwealth of Pennsylvania's Department of Health investigated the April 17thincident and reported that the decedent was the ninth mental health crisis patient to elope from the ER without any crisis intervention evaluation in a 31/2 month period. [Appellee] was cited by the Commonwealth for having violated regulations involving patient safety and protection and was issued a fine for [its] non-compliance.

         Trial court opinion, 10/18/13 at 2-3 (footnotes omitted).

         On February 1, 2016, appellee's preliminary objections to appellant's third amended complaint were sustained, and the complaint was dismissed with prejudice. The trial court determined[2] that the Mental Health Procedures Act ("MHPA"), 50 P.S. §§ 7101-7503, applied to this case, and therefore, appellant had to prove willful misconduct or gross negligence. The trial court then determined that at most, appellant's allegations rose to the level of ordinary negligence.[3] As such, appellee was entitled to the benefit of the MHPA's limited immunity provision. This timely appeal followed on February 22, 2016. On March 7, 2016, appellant was ordered to file a concise statement of errors complained of on appeal pursuant to Pa.R.A.P. 1925(b) within 21 days; appellant complied on March 24, 2016, and the trial court filed a Rule 1925(a) opinion on April 25, 2016.

         Appellant has raised the following issues for this court's review:

A. Whether the trial court committed an error of law when it applied the heightened Standard of the [MHPA] to the admission of decedent, Dawn M. Martin to [appellee], Holy Spirit Hospital on April 17, 2012?
B. Whether the trial court committed an error of law by dismissing, with prejudice, [appellant]'s Third Amended Complaint at the Preliminary Objection phase of litigation by determining Appellant had not pled sufficient facts to show gross negligence pursuant to the [MHPA]?

         Appellant's brief at 5.

         The standard of review we apply when considering a trial court's order sustaining preliminary objections is well settled:

[O]ur standard of review of an order of the trial court overruling or granting preliminary objections is to determine whether the trial court committed an error of law. When considering the appropriateness of a ruling on preliminary objections, the appellate court must apply the same standard as the trial court.
Preliminary objections in the nature of a demurrer test the legal sufficiency of the complaint. When considering preliminary objections, all material facts set forth in the challenged pleadings are admitted as true, as well as all inferences reasonably deducible therefrom. Preliminary objections which seek the dismissal of a cause of action should be sustained only in cases in which it is clear and free from doubt that the pleader will be unable to prove facts legally sufficient to establish the right to relief. If any doubt exists as to whether a demurrer should be sustained, it should be resolved in favor of overruling the preliminary objections.

HRANEC Sheet Metal, Inc. v. Metalico Pittsburgh, Inc., 107 A.3d 114, 118 (Pa.Super. 2014).

In 1976, the General Assembly enacted the MHPA to provide procedures and treatment for the mentally ill in this Commonwealth. The policy of the MHPA is set forth in Section 102, which provides, in pertinent part:
[I]t is the policy of the Commonwealth of Pennsylvania to seek to assure the availability of adequate treatment to persons who are mentally ill, and it is the purpose of this act to establish procedures whereby this policy can be effected. The provisions of this act shall be interpreted in conformity with the principles of due process to make voluntary and involuntary treatment available where the need is great and its absence could result in serious harm to the mentally ill person or to others. Treatment on a voluntary basis shall be preferred to involuntary treatment; and in every case, the least restrictions consistent with adequate treatment shall be employed.

Allen v. Montgomery Hosp., 696 A.2d 1175, 1178 (Pa. 1997), quoting 50 P.S. § 7102.

The immunity provision of the MHPA provides in pertinent part as follows:
§ 7114. Immunity from civil and criminal liability
(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, . . . shall not be civilly or criminally liable for such decision or for any of its consequences.
50 P.S. § 7114(a). Under the MHPA, a "facility" is "any mental health establishment, hospital, clinic, institution, center, day care center, base service unit, community mental health center, or part thereof, that provides for the diagnosis, treatment, care or rehabilitation of mentally ill persons, whether as outpatients or inpatients." 50 P.S. § 7103. "Treatment" is defined as "diagnosis, evaluation, therapy, or rehabilitation needed to alleviate pain and distress and to facilitate the recovery of a person from mental illness and shall also include care and other services that supplement treatment and aid or promote such recovery." 50 P.S. § 7104.

Downey v. Crozer-Chester Med. Ctr., 817 A.2d 517, 524 (Pa.Super. 2003) (en banc), appeal denied, 842 A.2d 406 (Pa. 2004).

Our Supreme Court has determined that the immunity provided by the MHPA extends to institutions, as well as natural persons, that provide care to mentally ill patients. Farago v. Sacred Heart General Hospital, 522 Pa. 410, 562 A.2d 300, 303 (1989). Additionally, our Supreme Court has interpreted § 7114(a) to include not only treatment decisions, but also, "'care and other services that supplement treatment' in order to promote the recovery of the patient from mental illness." Allen v. Montgomery Hospital, 548 Pa. 299, 696 A.2d 1175, 1179 (1997).

Downey, 817 A.2d at 525. See also Farago v. Sacred Heart Gen. Hosp., 562 A.2d 300, 303 (Pa. 1989) ("Unquestionably, the clear intent of the General Assembly in enacting Section 114 of the MHPA was to provide limited civil and criminal immunity to those individuals and institutions charged with providing treatment to the mentally ill.").

         First, we address appellant's contention that the immunity provisions of the MHPA do not apply because appellee was not providing mental health "treatment" to the decedent at the time of her injury and death. Appellant argues that the decedent had not yet been evaluated by any physicians, crisis intervention personnel, or mental health professionals while in the ER, and no decisions regarding her care or treatment were made while the decedent was at appellee's facility. (Appellant's brief at 17.) The decedent had not been admitted to the hospital and had not been examined by a physician or psychiatrist in the ER. (Id. at 16.) Appellant contends that because the decedent was not receiving "inpatient treatment" while a "resident" at the facility, the MHPA does not apply. (Id., citing 50 P.S. § 7103 ("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. "Inpatient treatment" shall include all treatment that requires full or part-time residence in a facility.").)

         Appellant relies primarily on this court's decision in Fogg v. Paoli Mem'l Hosp., 686 A.2d 1355 (Pa.Super. 1996), in which this court held that the immunity provisions of the MHPA did not apply because the defendant-hospital had not been "treating" the plaintiff-decedent, Edward H. Fogg, for his mental illness at the time of his injury. We find Fogg to be factually distinguishable. In that case, Mr. Fogg's treating psychiatrist arranged for him to be admitted to the psychiatric wing of Paoli Memorial Hospital. Id. at 1356. Mr. Fogg had a history of psychiatric problems including anxiety, depression, and audio/visual hallucinations. Id. When Mr. Fogg and his parents arrived at the ER, they were instructed to have a seat in the waiting room. Id. Mr. Fogg's parents told the registrar that their son was having hallucinations and had a bed reserved for his admission in the psychiatric ward. Id. Mr. Fogg did not receive any medical treatment and was not seen by any medical personnel. Id. at 1356-1357.

         Eventually, after repeated inquiries by Mr. Fogg's parents, the registrar directed them to the hospital admissions desk. Id. at 1357. The Foggs proceeded down the hallway unescorted. Id. At the end of the hallway was a large window, facing west into the setting sun. Id. Mr. Fogg became agitated and ran down the hallway towards the setting sun, crashing through ...

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