Leight v. Univ. of Pittsburgh Physicians

• Decision Date: 22 December 2020
• Docket Number: No. 35 WAP 2019,35 WAP 2019
• Citation: 243 A.3d 126
• Parties: Kathryn F. LEIGHT and John L. Leight, Her Husband, Appellants v. UNIVERSITY OF PITTSBURGH PHYSICIANS, UPMC, University of Pittsburgh of the Commonwealth System of Higher Education, Susan Shick, and Phillip L. Clark, Administrator of the Estate of John F. Shick, Deceased, Appellees
• Court: Pennsylvania Supreme Court

243 A.3d 126

Kathryn F. LEIGHT and John L. Leight, Her Husband, Appellants

v.UNIVERSITY OF PITTSBURGH PHYSICIANS, UPMC, University of Pittsburgh of the Commonwealth System of Higher Education, Susan Shick, and Phillip L. Clark, Administrator of the Estate of John F. Shick, Deceased, Appellees

No. 35 WAP 2019

Supreme Court of Pennsylvania.

Argued: May 19, 2020

Decided: December 22, 2020

OPINION

JUSTICE TODD

In this discretionary appeal, we consider the viability of a cause of action by a third party against, inter alia , physicians under the Mental Health Procedure Act ("MHPA" or "Act").¹ For the reasons explained below, we find that physicians are not liable under the MHPA for considering, but not formalizing the prerequisites for, an involuntary emergency examination. Accordingly, we affirm the order of the Superior Court.

This appeal arises from a tragic shooting incident on March 8, 2012, wherein John F. Shick, a 30-year-old adult, living independently, killed one person and injured several others at Western Psychiatric Institute and Clinic ("WPIC") in Pittsburgh. The injured persons included WPIC receptionist, Appellant Kathryn Leight. Subsequently, Ms. Leight and her husband John Leight (collectively, "Appellants"), filed a complaint against various defendants as described infra .

By way of background, the General Assembly enacted the MHPA in 1976. The purpose of the MHPA is to establish procedures to effectuate the Act's policy — assuring the availability of adequate treatment to those who are mentally ill. 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 . Indeed, treatment under the MHPA can be broadly conceptualized as two types, voluntary and involuntary. The General Assembly stressed that treatment on a voluntary basis is preferable to involuntary treatment, and, in all instances, the least restrictive approach consistent with adequate treatment should be utilized. Id . Critical to the resolution of the instant appeal, and as discussed below in greater detail, the scope of the MHPA is limited, as it establishes rights and procedures only for the involuntary treatment of mentally ill persons, whether inpatient or outpatient, and for the voluntary inpatient treatment of mentally ill persons. Thus, the voluntary treatment of outpatients falls outside the scope of the MHPA.

In furtherance of the policy of the MHPA, the General Assembly also provided limited immunity for certain individuals providing care to the mentally ill. Specifically, 50 P.S. § 7114 protects from civil and criminal liability those individuals and institutions that provide treatment to mentally ill patients, and, thus, promotes the statutory goal of ensuring such treatment remains available. Dean v. Bowling Green-Brandywine , ––– Pa. ––––, 225 A.3d 859, 869 (2020). This immunity protection, however, does not insulate individuals from liability for acts of willful misconduct or gross negligence. 50 P.S. § 7114.

Generally speaking, a medical professional has no duty under the common law to control the conduct of a patient or warn or protect a third party from a threat by a patient in his or her care, except under certain limited circumstances. See generally Maas v. UPMC Presbyterian Shadyside , ––– Pa. ––––, 234 A.3d 427 (2020) ; Emerich v. Philadelphia Center for Human Development, Inc. , 554 Pa. 209, 720 A.2d 1032 (1998). However, in tort cases, a duty may be imposed, not only by the common law, but also through statute. Based upon Section 114, our Court has found an affirmative duty exists under the MHPA which requires mental health professionals and institutions to avoid willful misconduct or gross negligence in the treatment of mental health patients, and imposes civil liability for a breach of that duty.

Goryeb v. Commonwealth, Department of Public Welfare , 525 Pa. 70, 575 A.2d 545, 548-49 (1990) (finding a party participating in a decision to examine, treat, or discharge a mentally ill patient under the MHPA who commits willful misconduct or gross negligence can be liable for such decision or for any of its consequences); see also Sherk v. Dauphin , 531 Pa. 515, 614 A.2d 226, 232 (1992) (plurality).

Finally, as this appeal arises in the context of preliminary objections, as explained below in greater detail, we must accept the allegations contained in the complaint, as amended, to understand the circumstances giving rise to this appeal and to analyze Appellants’ claims under the MHPA. With this background, we consider the appeal sub judice .

In their complaint, Appellants asserted, in relevant part, that Shick began experiencing behavior that suggested he was suffering from severe mental illness in February 2005, when Shick, then 24 years old, was residing in New York City. He was involuntarily committed and released on multiple occasions, with his final release while living in New York in June 2008. Thereafter, in April 2009, Shick was admitted to the chemistry program at Portland State University in Oregon as a doctoral student and graduate teaching assistant for the fall 2009 semester, and moved to Portland. While in Oregon, Shick was involuntarily committed in December 2009, and ultimately released in May 2010. He was expelled from the University.

In March 2011, Shick was accepted into Duquesne University's doctoral program in the Department of Biological Sciences in Pittsburgh, and was granted a graduate teaching assistantship. Approximately three months later, in June 2011, Shick established a patient-primary care physician relationship with University of Pittsburgh Physicians ("UPP"), and, specifically, with UPP doctors at University of Pittsburgh Medical Center's ("UPMC") Shadyside Family Health Center ("Shadyside Family"). Shick provided Shadyside Family with authorizations to obtain his prior treatment records, which revealed he had suffered from severe mental illness. At Shadyside Family, Shick initially complained to Dr. Thomas Weiner of neck and ankle pain, elevated cholesterol, and depression, for which Dr. Weiner prescribed, inter alia , physical therapy. Thus began an ongoing series of visits through the fall of 2011, during which Shick asserted various ailments – including headaches; neck, shoulder, chest, back, and ankle pain; belching; vomiting; and depression – for which Dr. Weiner prescribed a number of tests, treatments, and remedies.

On October 21, 2011, Dr. Weiner first recorded his impression that Shick's complaints of pain might be due to mental illness, that another psychiatric diagnosis besides depression was very likely, and that he may benefit from a psychiatric referral at some point. On November 4, 2011, Shadyside Family staff set up an appointment for Shick to be evaluated by WPIC personnel. Five days later, on November 9, 2011, Shick underwent a psychiatric diagnostic evaluation by a WPIC licensed clinical social worker. At the evaluation, Shick denied prior psychiatric treatment and denied his prior history of psychiatric symptoms, but explained that a psychologist friend had told him that he was bipolar and acknowledged that he had been discharged from the doctoral program at Duquesne as the result of harassment charges due to his unacceptable interactions with women.

After various interactions with medical personnel at Shadyside Family, and a referral for Shick to visit the UPMC gastrointestinal clinic, on November 26, 2011, Dr. Weiner called and spoke with Shick to advise him of abnormal blood work, and noticed Shick's "pressured speech." Appellants’ Second Amended Complaint at ¶ 204. As a result, Dr. Weiner encouraged him to be treated by a psychiatrist, which, at that time, Shick rejected. Two days later, however, on November 28, 2011, Shick underwent the recommended evaluation by UPP psychiatrist Jatinder Babbar, M.D., at WPIC. At the evaluation, Shick denied prior psychiatric treatment, avoided questions, exhibited disorganized thinking, and denied suicidal or homicidal ideations. Dr. Babbar called Shick's mother, Susan Shick, who advised the physician that Shick had five prior psychiatric admissions, including the admission in Portland in 2010. As, according to Shick's mother, the medication Abilify

and individual psychiatric therapy had been effective in the past, Dr. Babbar strongly encouraged Shick to start that medication and begin therapy, which Shick refused to do. At that time, Dr. Babbar diagnosed Shick as schizophrenic and noncompliant with his medications.

On November 29, 2011, Dr. Weiner sent an email to UPP psychiatrist Stephanie Richards, M.D., who was on the staff of Shadyside Family, explaining his observations regarding Shick's behavior. After visits to various gastroenterology physicians, on December 23, 2011, Shick was seen by Dr. Weiner about his elevated potassium level. Shick stated his belief that he had the ability to control his own potassium level. Shick also complained of regular severe headaches and pain, which he was unable to characterize. Shick then accused Dr. Weiner of "being like his mother" in asking about the pain, and said he could articulate his pain only in essay form, which he would provide to Dr. Weiner in February, for Dr. Weiner to edit. Appellants’ Second Amended Complaint at ¶ 226. Dr. Weiner recommended that Shick begin taking anti-psychotic medication, and Shick responded in a grandiose and dismissive fashion. Dr. Weiner recognized that the physical pain complaints were "most likely" psychosomatic due to Shick's schizophrenia

, and then referred him to Dr. Richards, and again recommended anti-psychotic medications, which Shick refused, while continuing to deny his schizophrenia and prior treatment for it. Appellants’ Second Amended Complaint at ¶ 228.

On January 25, 2012, Shick was first evaluated by UPP...