In its decision filed on January 17, 2017, the Superior Court of Pennsylvania held that the trial court erred in dismissing the plaintiff’s mental health medical malpractice case, finding that the plaintiff had sufficiently pled gross negligence in her Pennsylvania mental health malpractice complaint.
The Underlying Facts
The decedent had a history of mental health problems and was brought by ambulance to the defendant hospital’s emergency department on April 17, 2012, following a suicide attempt. The decedent requested that she be voluntarily committed for psychiatric evaluation and care and was placed in an exam room.
Upon her arrival at the defendant’s emergency department (“ER”), the decedent voiced her suicidal intent several times to the defendant’s staff. At some point during her stay in the ER, the decedent changed into a hospital gown and slippers. She was not seen by a physician or the crisis intervention team during her time in the ER before eloping from the hospital: the decedent left her exam room and 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 defendant hospital through open sliding glass doors, still wearing her hospital gown and socks. At no point did any member of the defendant hospital’s staff intervene or question the decedent as she left the defendant hospital.
The decedent subsequently walked onto a nearby highway where she was struck and killed by passing motor vehicles.
The Commonwealth of Pennsylvania’s Department of Health investigated the incident and reported that the decedent was the ninth mental health crisis patient to elope from the defendant’s ER without any crisis intervention evaluation during a three-and-a-half-month period. The defendant hospital was cited for having violated regulations involving patient safety and protection and was issued a fine for its non-compliance.
The Appellate Court Decision
The Appellate Court stated that the trial court was correct in determining that the Mental Health Procedures Act (“MHPA”), 50 P.S. §§ 7101 -7503, applied to this case, and therefore, the plaintiff had to prove willful misconduct or gross negligence. While the trial court found that the plaintiff’s allegations, at most, rose to the level of ordinary negligence, the Appellate Court disagreed and held that the plaintiff’s complaint sufficiently alleged gross negligence.
The Appellate Court rejected the plaintiff’s contention that the immunity provisions of the MHPA do not apply because the defendant hospital was not providing mental health “treatment” to the decedent at the time of her injury and death. Although the decedent was never evaluated by a physician or a psychiatrist and was never formally admitted to the hospital, and there were no treatment decisions made on her behalf, the decedent was seen by trained nursing staff and some degree of professional medical care was administered (the decedent in this case was seen by ER nursing staff who documented her psychiatric history and her recent suicide attempt, and the decedent was given a bed, a hospital gown and slippers, and orange juice).
The Appellate Court stated, “we cannot say that the decedent was not being “treated” for purposes of the MHPA, which includes diagnosis and evaluation by any authorized person” (consistent with the purposes of the MHPA, treatment is given a broader meaning in the MHPA to include medical care coincident to mental health care) “we agree with the trial court that [the defendant hospital] was entitled to invoke the immunity provision of Section 7114 of the MHPA, unless its actions in treating the decedent constituted willful misconduct or gross negligence.”
The Appellate Court stated that the plaintiff’s complaint alleges that the defendant hospital grossly deviated from the accepted standard of mental-health care in failing to place the decedent in a secure location, failing to provide nursing supervision to a suicidal patient, failing to implement a “fail safe system” of preventing the elopement of mental-crisis patients from the ER with door locks, alarms, badge-swipe systems, etc., failing to follow its own protocols for suicidal patients, failing to call crisis intervention to evaluate the decedent, and failing to act upon security surveillance footage showing the decedent eloping from the ER. In addition, the plaintiff alleged that the defendant hospital knew it had a problem with mental crisis patients eloping from its facility and failed to take any action to protect future patients such as the decedent.
The plaintiff alleged that the defendant hospital failed to take adequate precautions to assure the decedent’s safety: according to the defendant hospital’s own protocols, the decedent should have received close monitoring with 1:1 observation; the decedent waited one and a half hours in the ER without being evaluated by a physician, psychiatrist, or crisis intervention staff; and, the decedent was the ninth mental-crisis patient in the past three and a half months to elope from the ER, yet the defendant hospital failed to take any measures to protect future mental-crisis patients such as installing door locks and alarms.
The Appellate Court held that based on the facts pled in the plaintiffs’ third amended complaint, a jury could find that the defendant hospital’s actions constituted gross negligence, as they could be interpreted as “flagrant, grossly deviating from the ordinary standard of care.”
Source Martin v. Holy Spirit Hospital, 2017 PA Super 11.
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