HomeMy WebLinkAbout2012-665
IN RE: : IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NANCY WHITE VENCIL :
: NO. 2012 – 0665 CIVIL TERM
:
:
: CIVIL ACTION – EQUITY
:
IN RE: OPINION PURSUANT TO Pa. R.A.P. 1925
Guido, J., July , 2014
Petitioner filed a request to expunge her mental health records in accordance with 18
Pa. C.S.A. § 6111.1 (g) (l) (i). After an evidentiary hearing we denied her request. She has filed
the instant appeal. While she raises a plethora of alleged errors, they all fall into one of two
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categories. The majority of the alleged errors involve our finding that there was sufficient
evidence to justify her involuntary commitment under Section 302 of the Mental Health and
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Procedures Act (hereinafter the Act). She also contends that we erred in allowing respondent
Holy Spirit Hospital to participate in the proceedings. We will discuss each of those issues in
this opinion.
FACTUAL BACKGROUND
We will start with a recitation of the facts as we found them to be. On the evening of
April 1, 2003 Petitioner went to the emergency room at the Holy Spirit Hospital complaining of
1
We note that her “Concise Statement of Errors Complained of on Appeal” is far from concise.
2
50 P.S. § 7302.
3
“burning eyes, swollen nostrils, and pulmonary problems.” She also “asked for her saliva to be
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tested.”
As it turns out petitioner had suffered a “chemical injury” from a household product the
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previous year. The injury resulted in an “environmental illness” and various complications.
Since suffering the injury she was unable to live with her husband in their home. Over the 6
months immediately prior to April 1 she had stayed in at least 10 different hotels; had lived
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with her parents; and had even tried “corporate housing.” By her own admission, when she
presented to the emergency room she was “depressed”, “extremely frustrated” and “cried at
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times.” Because of petitioner’s emotional state the emergency room physician summoned her
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sister to the hospital and requested the involvement of a crisis worker.
David Diehl is a trained crisis worker who has been with the Holy Spirit Behavioral
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Health Center since 1985. He met with petitioner and her sister at 9:21 p.m. on April 1,
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2003. He spent a good deal of time talking with her. Petitioner reported that she had been
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sleeping very little and not eating well as a result of her illness. She also reported being
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depressed and feeling hopeless. She cried nearly non-stop during their time together.
3
Respondent’s Exhibit 1, p. 29.
4
Id.
5
Notes of Testimony, January 17, 2014. P. 7.
6
Id.
7
Notes of Testimony, January 17, 2014, p. 27.
8
Notes of Testimony, January 17, 2014, pp. 20, 21.
9
Notes of Testimony, January 17, 2014, pp. 20, 21.
10
Notes of Testimony, January 17, 2014, p. 37.
11
Respondent’s Exhibit 1, p. 29.
12
Notes of Testimony, January 17, 2014, p. 40.
13
Respondent’s Exhibit 1, p. 29.
14
Notes of Testimony, January 17, 2014, p. 41.
15
Notes of Testimony, January 17, 2014, p. 41.
2
Eventually Mr. Diehl and her sister convinced petitioner to voluntarily admit herself to
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the psychiatric unit for treatment. However, when they got to the unit, petitioner changed
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her mind. At some point thereafter she told Mr. Diehl that she wanted to kill herself.
Mr. Diehl was very concerned about petitioner’s mental state. He advised her that she
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should not leave the hospital. After some discussion they all agreed to a safety plan where
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she would go home with her sister. However, as petitioner put it, “Once I got to the door, I
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fled.”
21
Mr. Diehl watched as she jumped into her car and “took off.” Even though it was after
midnight she drove with her headlights off and traveled the wrong way on a one-way road as
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she left the parking lot. Mr. Diehl was “very nervous” and afraid she might be involved in a
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collision.
24
At that point, Mr. Diehl filled out an application for a 302 commitment. Sometime
later he was called by one of petitioner’s friends who reported that petitioner was just sitting in
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her car parked in the friend’s driveway. By the time the police responded, she was gone. At
16
Notes of Testimony, January 17, 2014, p. 42.
17
Notes of Testimony, January 17, 2014, pp. 42, 43; Exhibit 1, p. 11.
18
Notes of Testimony, January 17, 2014, p. 11.
19
Notes of Testimony, January 17, 2014, pp. 11, 43.
20
Notes of Testimony, January 17, 2014, p. 12.
21
Notes of Testimony, January 17, 2014, p. 44.
22
Notes of Testimony, January 17, 2014, p. 44.
23
Notes of testimony, January 17, 2014, p. 44.
24
50 P.S. § 7302.
25
Respondent’s Exhibit 1, p. 31.
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10:40 a.m. on April 2 the same friend called again to express concern for petitioner’s safety and
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to tell him the hotel where petitioner could be found.
The police located petitioner at the hotel. They transported her to Holy Spirit Hospital
to be examined pursuant to the warrant issued in connection with the 302 application. Upon
arrival Mr. Diehl explained the “Patient’s Rights” form to her, but she did not appear to
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understand. At 2:10 p.m. on April 2, 2003 she was examined by the psychiatrist David
Petcash, M.D. After noting the history which included many of the facts recited above, he
recorded the results of his “mental status examination” which included the following:
Patient is a 49 year old white female who was seen in the ECU. She was dressed in
normally appropriate clothing. Her reaction was one of poor cooperation. Her eye
contact was poor. Patient did have some psychomotor agitation present. Patient was
alert, oriented x 3. Mood appeared to be extremely anxious and dysphoric as well as
irritable. Her affect was at times labile. . . . Insight and judgment into her condition
appear to be impaired. Also, it was noteworthy that patient continued to have apparent
delusions regarding sensitivity to multiple environmental agents described above,
28
including exposure to “Turtle Wax.”
His provisional diagnosis included, inter alia, “delusional disorder”, “depressive disorder, nos”
29
and “rule out major depression, severe, with psychotic features.” Dr. Petcash determined
that Petitioner should be involuntarily committed for further treatment in accordance with
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Section 302 of the Act.
26
Respondent’s Exhibit 1, p. 31.
27
Respondent’s Exhibit 1, p. 13.
28
Respondent’s Exhibit 1, p. 33.
29
Respondent’s Exhibit 1, p. 35.
30
Respondent’s Exhibit 1, p. 15.
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31
Petitioner was admitted to the psychiatric unit on suicide watch. She was transferred
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to the care of another psychiatrist, Sylvester De La Cruz, M.D. She would only talk with Dr.
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De La Cruz in the presence of her husband and her lawyer.
Dr. De La Cruz met with petitioner, her husband, and her lawyer at 3:30 p.m. on April 3,
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2003. They all asked Dr. De La Cruz to discharge her. Apparently at the doctor’s request,
petitioner wrote the following statement on her chart:
“I do not have thoughts of suicide nor do I desire to harm myself or others. I only wish
to gain relief from multiple chemical sensitivities. I look forward to my full recovery
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soon!”
While Dr. De La Cruz suggested that she remain in the unit for treatment on a voluntary basis,
3637
petitioner refused. She did agree to pursue individual counselling as an outpatient. Being
satisfied that there were no grounds for “further 302 commitment”, Dr. De La Cruz discharged
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her.
DISCUSSION
Sufficiency of Evidence
“The Commonwealth’s right to impinge upon the freedom of a mentally ill person for his
or her own benefit is based on the doctrine of parens patriae, i.e., that the state has a solemn
duty to safeguard the welfare of the individual. . . . The authority to confine dangerous persons
31
Respondent’s Exhibit 1, p. 36.
32
Respondent’s Exhibit 1, p. 41.
33
Respondent’s Exhibit 1, p. 41.
34
Respondent’s Exhibit 1, p. 42.
35
Respondent’s Exhibit 1, p. 42.
36
Respondent’s Exhibit 1, p. 42.
37
Respondent’s Exhibit 1, p. 42.
38
Respondent’s Exhibit 1, p. 43.
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arises from the state’s inherent police powers.” In re Commitment of Donna Hutchinson, 454
A.2d 1008, (Pa. 1982). On the other hand, one who has been unlawfully committed “has a
constitutional right to the destruction of hospital records created as a result of the illegal
commitment.” In Re: R.F. 914 A.2d 907, 908 (Pa. Super 2006).
The Mental Health Procedures Act governs the involuntary commitment and treatment
of the mentally ill. Section 301 of the Act provides in relevant part as follows:
§7301. Persons who may be subject to involuntary emergency examination and
treatment
(a)Persons Subject. – Whenever a person is severely mentally disabled and in need of
immediate treatment, he may be made subject to involuntary emergency
examination and treatment. A person is severely mentally disabled when, as a result
of mental illness, his capacity to exercise self-control, judgment and discretion in the
conduct of his affairs and social relations . . . is so lessened that he poses a clear and
present danger of harm to others or to himself.
(b)Determination of Clear and Present Danger. – (2) Clear and present danger to
himself shall be shown by establishing that within the past 30 days:
(ii) the person has attempted suicide and that there is the reasonable probability of
suicide unless adequate treatment is afforded under this act. For the purposes of
this subsection, a clear and present danger may be demonstrated by the proof that
the person has made threats to commit suicide and has committed acts which are in
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furtherance of the threat to commit suicide . . .
Section 302 of the Act authorizes the involuntary commitment and treatment of a “severely
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mentally disabled” person for up to 120 hours.
Based upon the testimony we heard as well as a thorough review of the medical
records, we were satisfied that there was clear and convincing evidence to support petitioner’s
39
50 P.S. § 7301.
40
50 P.S. § 7302.
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302 commitment. Petitioner was obviously distraught and emotional when she presented
herself to the emergency room. She was depressed, felt hopeless, and cried continuously.
After much discussion her sister and Mr. Diehl were able to convince her that she should
voluntarily admit herself for treatment in the psychiatric unit.
It was after midnight when they got to the psychiatric unit where petitioner changed her
42
mind and refused treatment. Sometime thereafter she told Mr. Diehl that she wanted to kill
herself. While he was very concerned he felt comfortable in allowing her to go home so long as
she was accompanied by her sister. However, petitioner fled as soon as they reached the door.
She jumped in her car and drove away very erratically. Her articulated desire to commit suicide
coupled with those subsequent actions were sufficient to satisfy the “clear and present danger”
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requirement of the Act.
Petitioner’s erratic behavior continued after she left the hospital. She drove around for
some time. She went to a friend’s home, but just sat in her car. She was located later that
morning at a local hotel; returned to Holy Spirit and examined by psychiatrist Dr. David Petcash.
He determined that she was in need of further treatment, which determination was supported
by the record.
Petitioner pointed out that the delusional diagnosis of Dr. Petcash (and Mr. Diehl for
that matter) was in error. Therefore, she argued that her commitment was inappropriate. We
41
While it is not clear that the law requires clear and convincing evidence to justify a 302 commitment, we applied
that standard by agreement of all parties.
42
In her brief Petitioner pointed to the unit psychiatrist’s conclusion that she did not meet the criteria for a 302
commitment. However, this conclusion was reached after she had refused voluntary treatment but before she had
articulated a desire to kill herself.
43
50 P.S. §7301 (b) (2) (ii).
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agreed that the delusional diagnosis was erroneous. We did not agree that the commitment
was inappropriate. While the symptoms of her environmental illness may very well have been
real, so were the side effects of battling those symptoms. She was depressed, felt hopeless,
and articulated a desire to commit suicide. Those side effects coupled with her actions justified
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the 302 commitment.
Finally, petitioner argued that even Dr. De La Cruz supported her position. She pointed
out that he discharged her the very next day. She also contended that he concluded there were
no grounds for the 302 commitment, thereby invalidating the whole process. However, her
arguments were belied by the facts.
Dr. De La Cruz’s actual conclusion at discharge was that there were no grounds for
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“further” 302 commitment. This decision was made after he secured petitioner’s assurance
that she had no current thoughts of suicide and that she would pursue individual counselling on
an outpatient basis. Under the terms of the Act he had no choice. He was required to release
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petitioner once it appeared that there was “no longer a need for immediate treatment.”
Permitting Holy Spirit to Participate in the Proceedings
Petitioner argued that Holy Spirit’s late response to her petition should bar it from
participating in the proceedings. We disagreed. This action was commenced by petition filed
on February 3, 2012. A rule to show cause was issued upon the Pennsylvania State Police and
44
As Mr. Diehl put it “you can be delusional and not need to be admitted to the facility.” Notes of Testimony, p.
56.
45
It is noteworthy that he suggested she remain in the hospital for voluntary treatment.
46
50 P.S. § 7302 (b).
8
Holy Spirit Hospital on February 13, 2012. The Pennsylvania State Police filed a response. Holy
Spirit Hospital did not.
There was no further docket activity until May 9, 2013 when petitioner’s new counsel
entered his appearance. On August 23, 2013 new counsel filed a “Petition to Make Rule
Absolute or in the Alternative to Schedule a Hearing.” On August 28, 2013 counsel for Holy
Spirit Hospital entered his appearance. On August 30, 2013 we scheduled a hearing for October
25, 2013.
Holy Spirit Hospital filed its answer to the original Rule to Show Cause on October 23,
2013. On that same date petitioner requested a continuance of the October 25, 2013 hearing.
Her continuance request indicated, inter alia, that Holy Spirit’s counsel would attend the
hearing and did not object to the continuance. We rescheduled the hearing for January 7,
2014.
On November 7, 2013 petitioner filed a request to strike Holy Spirit’s answer and to
preclude it from participating in the proceedings. We heard argument on the request
immediately prior to the start of the evidentiary hearing.
In the interest of fairness we denied petitioner’s request. Petitioner had not taken any
action for more than 18 months after she filed the original petition. As soon as she requested a
hearing on the matter Holy Spirit’s counsel entered his appearance. Its answer and new matter
were filed prior to the date scheduled for the original hearing. In light of the long delay by
petitioner in prosecuting this action, we saw no reason to bar Holy Spirit’s participation because
of its delay in defending it.
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Furthermore, we were satisfied that petitioner would not be prejudiced by allowing
Holy Spirit to participate. The parties had stipulated to the admission of petitioner’s hospital
records. The crisis worker had been subpoenaed and was present at the hearing. Had we
barred Holy Spirit’s participation, the hospital records would have been proffered, and Mr.
Diehl would have been questioned, by the State Police. Furthermore, since the hearing did not
take place until three months after Holy Spirit’s answer and new matter were filed, petitioner
had more than adequate time to prepare.
______________________ _________________________
DATE Edward E. Guido, J.
DARRELL C. DETHLEFS, ESQUIRE
2132 MARKET STREET
CAMP HILL, PA 17011
JOHN R. NINOSKY, ESQUIRE
P.O. BOX 109
LEMOYNE, PA 17043
CARLTON M. SMITH, ESQUIRE
1800 ELMERTON AVENUE
HARRISBURG, PA 17110
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