Applicability of Immunity Provisions of the Mental Health Procedures Act
Wunderly v. Saint Luke’s Hosp., 2023 WL 3993737 (Pa. Super. 2023) (unreported), allocatur granted Dec. 27, 2023, appeal docket 119 MAP 2023
In this case, the Supreme Court will consider whether the Mental Health Procedures Act (MHPA) immunity provisions (which shield conduct except willful and gross negligence) apply where the injuries the decedent allegedly suffered after being involuntarily admitted for mental health treatment were unrelated to treatment for mental health conditions that underpin the immunity provisions of the MHPA.
Superior Court summarized the factual background as follows:
In June 2021, Wunderly filed a wrongful death and survival action asserting claims of negligence and corporate negligence against St. Luke’s. She alleged Kenneth was admitted to St. Luke’s Hospital – Sacred Heart Campus on September 28, 2019, and, when admitted, he was documented with Stage I pressure ulcers to his right and left buttocks. Complaint at ¶ 23. During his admission, Kenneth acquired pressure related skin breakdown, pressure wounds, and the deterioration of existing pressure wounds. Id. at ¶ 24. She alleged that on or about October 14, 2019, while still a patient at St. Luke’s, Kenneth was documented with unstageable pressure ulcers to his right buttocks and posterior perineum, and deep tissue injury pressure wounds to his left buttocks and left heel. Id. at ¶ 25. That same day he was transferred to a different facility. Id. at ¶ 26. Kenneth died on October 24, 2019. Wunderly alleges the pressure ulcers and wounds caused and/or contributed to Kenneth’s death.
Wunderly alleged St. Luke’s was negligent by failing to: adopt proper protocols for pressure ulcer prevention; properly assess Kenneth’s risk of pressure ulcer development and risk of breakdown in light of his limited mobility and other risk factors; rotate, turn, or position Kenneth to avoid pressure ulcer formation and deterioration and develop a written plan for the same; monitor for pressure ulcer formation; use frequent turning to relieve pressure on pressure points; provide sufficient nutrition to meet Kenneth’s needs; identify and properly diagnose Kenneth’s pressure ulcers in a timely manner; timely complete weekly skin assessments and document same; prevent formation of pressure ulcers; provide appropriate wound care; timely and properly order and/or implement appropriate pressure ulcer interventions; provide complete and consistent documentation as to the condition of the pressure ulcers and Kenneth’s general medical condition; and implement an individualized care plan. Id. at ¶ 31. For the corporate negligence claim, Wunderly alleged St. Luke’s failed to: use reasonable care in the maintenance of the facility and equipment used for prevention and treatment of pressure wounds; select and retain competent nursing staff; oversee the provision of wound care and bed sore care by the nursing staff; and formulate, adopt, and enforce adequate rules and policies to ensure quality wound care and bed sore prevention. Id. at ¶ 36.
Slip op. at 2-3. In its answer, St. Luke’s alleged that it is immune from legal action under Section 114 of the MHPA because Kenneth was admitted to St. Luke’s for mental health treatment under a 302 petition under the MHPA and remained involuntarily admitted under Section 303. St. Luke’s moved for judgment on the pleadings. The trial court entered judgment in favor of St. Luke’s and against Wunderly, concluding St. Luke’s was immune under the MHPA unless the conduct was willful or grossly negligent and the complaint lacked facts to support such a finding. Wunderly appealed to Superior Court on the basis that the immunity provisions of the MHPA do not apply to the claims, arguing, as summarized by Superior Court:
Wunderly first contends that the trial court erred in granting St. Luke’s motion for judgment on the pleadings because the immunity provisions of the MHPA do not apply to the claims. Wunderly argues that affording St. Luke’s immunity “would not advance the purposes of” the MHPA. Wunderly’s Br. at 17. She maintains the development of pressure wounds was not the result of a “treatment decision,” arguing that, taking all inferences in favor of Wunderly, “by their very nature, for pressure injuries of this type and severity to develop and deteriorate, [St. Luke’s] must have altogether ignored [Kenneth] for prolonged periods of time.” Id. She argues that “offloading pressure from the vulnerable decedent’s bony prominences cannot be said to be medical care in the same vein as contemplated by the [MHPA],” as she claims it does nothing to facilitate recovery from a mental illness. Id. at 17-18. Wunderly attempts to distinguish Allen v. Montgomery Hospital, 696 A.2d 1175 (Pa. 1997). She maintains that the decedent in Allen was injured by a restraint device intended to permit her to sit up in bed while preventing her from falling out of bed due to her mental health conditions. She argues that here, Kenneth’s injures bore “no relation to any treatment for mental health conditions that underpin the immunity provisions of the MHPA.” Id. at 16. She further claims the nursing staff is not a “person who participates in a decision that a person be examined or treated under” the MHPA and therefore immunity does not apply. Id. at 18.
Slip op. at 6.
Superior Court held that the trial court did not commit a clear error of law in finding the MHPA provided immunity unless the conduct was willful or grossly negligent and concluded that the allegations of the complaint did not rise to that level. Superior Court reasoned:
Here, the trial court concluded that the treatment Kenneth received for his pressure ulcers was incidental to the treatment for his dementia and mental health. Trial Court Opinion, filed Mar. 9, 2022, at 9. It reasoned that Kenneth was involuntarily admitted to St. Luke’s under the MHPA and treated for aggressive and combative behavior related to his dementia diagnosis. Id. It pointed out the primary reason for the hospitalization was to stabilize his mental health, and the treatment of his pressure ulcers was “coincident to that mental health treatment.” Id. The court therefore concluded that St. Luke’s was immune from suit unless the complaint alleged willful or grossly negligent conduct.
The trial court did not commit a clear error of law in finding the MHPA provided immunity unless the conduct was willful or grossly negligent. The treatment for and prevention of pressure ulcers and other wounds was coincident to the mental health care being provided by St. Luke’s, as it was medical care “necessary to maintain decent, safe and healthful living conditions,” and treatment that aided or promoted a recovery from a mental illness. See Allen, 696 A.2d at 1179.
Slip op. at 9.
The Pennsylvania Supreme Court will consider the following issue:
Did the Superior Court err in affirming the [t]rial [c]ourt’s grant of judgment on the pleadings in favor of St. Luke’s [d]efendants because the immunity provisions of the Mental Health Procedures Act do not apply to [Petitioner]’s claims?
For more information, contact Kevin McKeon or Dennis Whitaker.