Opinion
373 WDA 2023 J-A29003-23
05-13-2024
IN RE: M.A.C. APPEAL OF: M.A.C.
Appeal from the Order Entered March 3, 2023 In the Court of Common Pleas of Butler County Civil Division at No(s): MAD 2022-40326
BEFORE: BOWES, J., KUNSELMAN, J., and MURRAY, J.
OPINION
BOWES, J.
M.A.C. appeals the order denying his petition to expunge his involuntary mental health commitment pursuant to 50 P.S. § 7302 ("§ 302") of the Mental Health Procedures Act ("MHPA"). We affirm.
On November 2, 2022, Appellant filed the underlying petition in accordance with 18 Pa.C.S. § 6111.1(g)(2), seeking both expunction of his § 302 commitment and restoration of his firearms rights. During the ensuing hearing, the trial court found the following facts, which are not in dispute:
Since Appellant has not challenged the denial of his firearm rights, this appeal concerns only the denial of the portion of the petition requesting expungement of his commitment.
[Appellant] was involuntarily committed pursuant to [a six-part] application for involuntary emergency examination and treatment on April 1, 2022. The application's Part I was completed by Sgt. Donald Myers, Jr., which include[d] his observations and interactions of [Appellant]. His statement reads:
I was dispatched to the residence for persons inside residence. After checking exterior, then entrance, and finding nothing, it was found the subject hasn't slept in three days and hearing voices. Subject had HDAD [sic] and very paranoid. House complete mess. Doors and stairways barricaded with furniture. Responded two hours later. Still hearing voices and suspect inside residence. After negotiating for [forty-five] minute[s], finally made entry and once again found nothing. Kitchen area completely filthy with dirty dishes and pots over a week old. Found approximately [twenty] cases of water and ten to [fifteen] emergency meal buckets about the house. Due to the individual barricading exits with furniture, the children, 7-year-old boy, 8-year-old girl, would not be able to exit residence. At one point[, the] children were locked inside a bedroom closet. While [Children & Youth Services] caseworkers were speaking with [Appellant], the 7-year-old boy nearly knocked the couch onto himself.
When [Appellant] was taken from his residence for assessment and treatment, the two young children went into the care of Children & Youth Services. [Additionally, on Part I of the application, the sergeant checked a box indicating that he believed Appellant was severely mentally disabled and that treatment was necessary because he posed a clear and present danger to others.]
Alyssa Tomsey, D.O.[,] who stated her findings in Part VI of the application, examined [Appellant]. Her findings stated, "Paranoid" and "Auditory Hallucinations," with "Inpatient management" being recommended as the treatment needed. [Appellant] was committed for the maximum 120 hours. At the hearing the application came in as Plaintiff's Exhibit 1.Findings of Fact and Memorandum of Law, 6/7/23, at 1-2 (cleaned up).
On March 3, 2023, the trial court entered an order denying the petition to expunge and denying without prejudice the request for restoration of firearms rights. This timely appeal followed. The court ordered Appellant to file a concise statement of errors pursuant to Pa.R.A.P. 1925(b), and Appellant complied. The court further entered findings of fact and a memorandum of law addressing the claims raised in the Rule 1925(b) statement.
Appellant presents the following three issues for our review:
1. Where th[e Pennsylvania Supreme] Court has held that "both a threat and an act in furtherance must be proven" under 50 P.S. § 7301(b)(1) in In re B.W., 250 A.3d 1163 (Pa. 2021), did the trial court err in finding that there was sufficient evidence to involuntarily commit Appellant where there were no findings of a threat and/or an act in furtherance to commit harm in either the application for involuntary emergency examination and treatment or the trial court's opinion?
2. Where the trial court found that it was "not the role of the Court to second-guess a finding made by a physician that a [§] 302 commitment was medically necessary," did the trial court err in failing to apply the proper standard of review articulated in In re Vencil, [152 A.3d 235 (Pa. 2017),] in finding that there was sufficient evidence to involuntarily commit Appellant?
3. Where this Court has held that the provisions of the [MHPA], 50 P.S. §§ 7101 et seq., be strictly followed in In re A.J.N., 144 A.3d 130 (Pa.Super. 2016), did the trial court err in failing to order the expungement of Appellant's involuntary mental health commitment where the trial court found that "the Application was facially deficient"?Appellant's brief at 8 (cleaned up).
All of Appellant's claims concern the trial court's denial of his request for expunction made pursuant to § 6111.1(g)(2). Generally, we review the denial of such a petition for an abuse of discretion. See In re J.G.F., 295 A.3d 265, 269 (Pa.Super. 2023). However, "a challenge to the sufficiency of the evidence to support a 302 commitment presents a pure question of law," and therefore our standard of review is de novo. See In re Vencil, 152 A.3d at 246.
In pertinent part, § 6111.1(g)(2) provides as follows:
A person who is involuntarily committed pursuant to [§ 302] may petition the court to review the sufficiency of the evidence upon which the commitment was based. If the court determines that the evidence upon which the involuntary commitment was based was insufficient, the court shall order that the record of the commitment submitted to the Pennsylvania State Police be expunged.18 Pa.C.S. § 6111.1(g)(2).
Our High Court has stated that in conducting such a review,
the plain language of [§] 6111.1(g)(2) directs a trial court to review the physician's findings, made at the time of the commitment, to determine whether the evidence known by the physician at the time, as contained in the contemporaneously-created record, supports the conclusion that the individual required commitment under one (or more) of the specific, statutorily-defined circumstances.In re Vencil, 152 A.3d at 242 (citation omitted). "[T]he appropriate standard of proof applicable to the physician's record findings is a preponderance of the evidence standard." Id. at 246. Further, this section requires "deference to the physician, as the original factfinder, as the physician examined and evaluated the individual in the first instance, was able to observe his or her demeanor, and has particularized training, knowledge[,] and experience regarding whether a [§] 302 commitment is medically necessary." Id.
Our Supreme Court has recognized that by using the term of art "sufficiency of the evidence" within § 6111.1(g)(2), the legislature sought to adopt the ideas associated with that precise meaning, including the fact that we review all reasonable inferences consistent with the doctor's finding. Id. at 242-43 (noting that in other legal contexts, a "challenge to the sufficiency of the evidence . . . requir[es] review of fact of record in the light most favorable to the original decision-maker"); see also Commonwealth v Salinas, 307 A.3d 790, 793 (Pa.Super. 2023) (explaining that when reviewing the sufficiency of the evidence in the criminal context, we view the evidence "and all reasonable inferences derived therefrom" in the light most favorable to the verdict winner).
The Vencil Court also outlined the relevant portions of the MHPA thusly:
Pursuant to the MHPA, a person for whom there are reasonable grounds to believe that he or she is severely mentally disabled and in need of immediate treatment may be subjected to an involuntary examination by a physician. When an individual is brought in for an examination and determination of his or her need for emergency mental health treatment, the physician must determine, within two hours of the individual's arrival, whether the person is in fact "severely mentally disabled" and "in need of immediate treatment." 50 P.S. § 7302(b).
An individual is "severely mentally disabled" if "as a result of mental illness, his capacity to exercise self-control, judgment and discretion in the conduct of his affairs and social relations or to care for his own personal needs is so lessened that he poses a clear and present danger of harm to others or to himself." 50 P.S. § 7301(a). What constitutes a "clear and present danger" is also defined by statute:
(1) Clear and present danger to others shall be shown by establishing that within the past [thirty] days the person has inflicted or attempted to inflict serious bodily harm on another and that there is a reasonable probability that such conduct will be repeated. If, however, the person has been found
incompetent to be tried or has been acquitted by reason of lack of criminal responsibility on charges arising from conduct involving infliction of or attempt to inflict substantial bodily harm on another, such [thirty]-day limitation shall not apply so long as an application for examination and treatment is filed within [thirty] days after the date of such determination or verdict. In such case, a clear and present danger to others may be shown by establishing that the conduct charged in the criminal proceeding did occur, and that there is a reasonable probability that such conduct will be repeated. For the purpose of this section, a clear and present danger of harm to others may be demonstrated by proof that the person has made threats of harm and has committed acts in furtherance of the threat to commit harm.
(2) Clear and present danger to himself shall be shown by establishing that within the past [thirty] days:
(i) the person has acted in such manner as to evidence that he would be unable, without care, supervision and the continued assistance of others, to satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety, and that there is a reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within [thirty] days unless adequate treatment were afforded under this act[.]
. . . .
50 P.S. § 7301(b). If the examining physician determines that the person is "severely mentally disabled and in need of immediate treatment, treatment shall be begun immediately" and continue until "there is no longer a need for immediate treatment," up to 120 hours.Id. at 237-38 (cleaned up, emphases added).
Finally, we note that "involuntary civil commitment of mentally ill persons constitutes deprivation of liberty and may be accomplished only in accordance with due process protections." In re A.J.N., 144 A.3d at 137 (citation omitted).
With these principles in mind, we address Appellant's first two issues together. He argues initially that there was insufficient evidence supporting his § 302 commitment based upon a determination that he constituted a clear and present danger to others, as that was the basis for commitment indicated on the application. See Appellant's brief at 13-17. Specifically, Appellant contends that the record is "devoid of any infliction of serious bodily injury" or attempt to inflict such serious bodily injury upon anyone else, including the children in his home at the time of the incident. Id. at 14. Additionally, he highlights that there was no indication that he made any threats to anyone, or took any actions in furtherance of a threat, and therefore he could not be committed under the "threats and act" formulation of § 301(b). Id. at 15.
Relatedly, Appellant avers that expunction should have been granted because the trial court improperly deferred to the physician's unsupported findings, in contravention to our High Court's decision in Vencil. See Appellant's brief at 17-19. He claims that in denying his petition, the trial court "did not point to any specific evidence in the record establishing the need for . . . involuntary commitment, and, instead, appears to have entirely deferred to the physician's finding, despite the lack of supporting evidence." Id. at 18.
In addressing these two issues, the trial court found that Dr. Tomsey properly determined that, based upon the information before her, Appellant was "severely mentally disabled" and "in need of immediate treatment," thus satisfying § 301 of the MHPA. See Findings of Fact and Memorandum of Law, 6/7/23, at 3. It further noted that the physician was able to observe Appellant and had the particularized training and knowledge regarding the medical necessity of an involuntary commitment. Id. at 5. The court ultimately opined that it applied the proper standard of review and correctly concluded that "the recorded evidence of the physician, and the information she relied upon, support[ed] by a preponderance of the evidence [Appellant]'s involuntary commitment." Id. at 5-6.
On review, we agree with the trial court that there was sufficient evidence supporting Appellant's involuntary mental health commitment. As an initial matter, Appellant's arguments above rely on the premise that the court was required to determine exclusively whether Dr. Tomsey had sufficient evidence to find that Appellant was a clear and present danger to others, since Sergeant Myers indicated that section on Part I of the application for involuntary emergency examination and treatment. However, that is an improperly constrained interpretation of the trial court's standard of review. Section 6111.1(g)(2) only requires that the trial court determine "whether the evidence known by the physician at the time. . . supports the conclusion that the individual required commitment under one (or more) of the specific, statutorily-defined circumstances." In re Vencil, 152 A.3d at 242 (emphasis added). Thus, the statute does not preclude the examining doctor from considering any and all applicable sections of the MHPA in determining whether treatment is medically necessary. In other words, the doctor, who possesses specialized knowledge and training concerning mental health treatment, is not bound by a police officer's initial indication as to what provision of the MHPA should apply.
The evidence available to Dr. Tomsey at the time she examined Appellant supported the conclusion that he was severely mentally disabled, a clear and present danger to himself, and in immediate need of treatment. Specifically, there was evidence that Appellant had not slept in three days, heard voices in his head, believed erroneously that other people were inside of his home, barricaded the entrances and stairways in his residence, and locked his children in a closet. Appellant himself contacted the police for assistance based on the belief that someone was in the house, yet responding officers could not enter the residence to render aid for more than forty-five minutes because all entrances were blocked. The doctor also found upon her independent observation that Appellant was suffering from paranoia and auditory hallucinations and recommended that he receive immediate inpatient treatment by checking the appropriate box found on Part VI of the commitment application.
Collectively, this evidence, viewed in the light most favorable to the doctor as decision-maker, sustains the finding that Appellant was incapable of caring for his basic needs, and by necessity the needs of his minor children, and that there was a reasonable probability of Appellant's physical debilitation within thirty days if he did not receive the assistance of others. See 50 P.S. § 7301(b)(2)(i) (stating that a person is a clear and present danger to himself when he "would be unable, without care, supervision and the continued assistance of others, to satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety, and that there is a reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within [thirty] days unless adequate treatment were afforded under this act").
Since the physician properly found that commitment was necessary "under one . . . of the specific, statutorily defined circumstances" of the MHPA, there was sufficient evidence supporting Appellant's § 302 commitment. In re Vencil, 152 A.3d at 242. As such, the trial court properly denied the petition to expunge and did not err by deferring to Dr. Tomsey's supported findings.
The Dissent maintains that "[t]he doctor did not indicate that [Appellant] posed a threat of harm to himself" and that "[n]othing indicated that [Appellant] was neglecting serious medical treatment, or that he was unable to safely complete the activities of daily living[.]" Dissenting Opinion, at 14. In so doing, the Dissent appears to overlook the totality of the evidence presented to Dr. Tomsey and the reasonable inferences drawn therefrom, including that fact that Appellant self-reported that he had not slept for three days because of the auditory hallucinations and that police were unable to promptly provide the aid Appellant himself requested. Further, to the extent the Dissent declares that the examining physician was required to reiterate in her notes the evidence already included within the application to support her findings, that is at odds with our legislature's intent that we review sufficiency claims the same as we do in other legal contexts. In other settings, there is no requirement that the fact finder identify the pieces of evidence upon which the finding was premised, and this Court is not constrained from conducting a de novo, plenary review of all evidence before the fact finder.
Notably, Appellant did not assert in either his Rule 1925(b) statement or his initial brief to this Court that his due process rights were violated because the doctor committed him due to his inability to care for himself, despite what was marked on Part I of the commitment application by the sergeant prior to the examination. To the extent that Appellant raises this theory for the first time in his reply brief, see Appellant's reply brief at 6 (indicating that Appellant lacked notice of the section relied upon in his commitment), we find that the issue is waived. See Pa.R.A.P. 302(a) ("Issues not raised in the trial court are waived and cannot be raised for the first time on appeal.").
In his final issue, Appellant argues that the court erred in denying his petition for expungement because there was a facial defect on the commitment application. See Appellant's brief at 19-22. More particularly, he notes that on page three of the application, there was an option for Sergeant Myers to select between one of two boxes and that both had been checked with accompanying signatures. Id. at 20-21. Appellant cites the trial court's statement that this made the application "facially deficient" in support of his argument that his due process rights were violated, thus warranting expunction. Id. at 21. Appellant notes that even though the trial court viewed the error as de minimis, even minor due process violations warrant relief. Id. (citing In re A.J.N., 144 A.39 at 139).
Box A requested a warrant from the county administrator to take Appellant to a facility for examination and treatment. Box B requested that a treating facility examine Appellant, which is typically checked if the patient voluntarily travels to, or is already present at, such facility when an examination is requested. In this case, Box B was checked in error.
We have indicated that "[a] question regarding whether a due process violation occurred is a question of law for which our standard of review is de novo and the scope of review is plenary." Commonwealth v. Widger, 237 A.3d 1151, 1164 (Pa.Super. 2020) (citation omitted).
In denying relief as to this claim, the trial court noted that this portion of the application in question "simply laid out the signature of the officer who [was] requesting a warrant from the county administrator and the signature of a representative of the county administrator." See Findings of Fact and Conclusions of Law, 6/7/23, at 7 (unnecessary capitalization omitted). It determined that even though there was an error on the form, this deficiency failed to affect Appellant's procedural due process rights and similarly did not violate the procedures laid out in § 302 of the MHPA. Id. at 6. Critically, the court found that "[n]o argument was advanced by [Appellant] that there was a procedural failure in his detainment, transportation[,] or medical examination." Id. at 7.
We agree with the trial court that Appellant's due process rights were not violated. Although Appellant argues that the checking of both boxes created confusion as to whether he was illegally transported without a warrant, the record demonstrates that all procedures were properly followed in this case. Part III of the application clearly denoted that a representative of the county administrator issued a warrant authorizing Sergeant Myers to take Appellant to the hospital for examination before Appellant was transported. Then, Dr. Tomsey indicated on Part VI that Appellant was examined within two hours of his arrival at the hospital. Therefore, Appellant's involuntary mental health commitment was done in strict accordance with the procedures set forth in the MHPA, and the court did not err in denying the petition.
Further, Appellant has cited no authority supporting his bald assertion that checking both boxes on the application itself constituted a due process violation. Rather, his claim is substantially different from other matters wherein we determined that a procedural infringement necessitated relief. See, e.g., In re A.J.N., 144 A.3d at 139 (finding that expunction was warranted where the evidence established that A.J.N. was forcibly conveyed to a mental health treatment facility without a warrant based on allegations not observed by the arresting officer); Commonwealth v. C.B., 452 A.2d 1372, 1375 (Pa.Super. 1982) (involuntary commitment pursuant to § 7304 of the MHPA was improper when C.B. did not receive a full three days of notice before a required hearing).
Based on the above, we do not have cause to disturb the order denying Appellant's petition for expunction. Accordingly, we affirm the trial court's order.
Order affirmed.
Judge Murray joins this Opinion.
Judge Kunselman files a Dissenting Opinion.
DISSENTING OPINION
KUNSELMAN, J.
I believe there was insufficient evidence to support an involuntary 302 commitment of M.A.C., and I would reverse the order denying his petition under the Uniform Firearms Act, 18 Pa. C.S.A. § 6111.1(g)(2), to expunge the record of that commitment. In denying M.A.C.'s expungement petition, the trial court deferred to the doctor's conclusion that M.A.C. needed inpatient treatment, without examining the facts upon which that conclusion was based. Trial Court Findings of Fact and Conclusions of Law, 3/3/23, at 3-4. The trial court did not indicate whether M.A.C. posed a threat of harm to himself or others; it only upheld the commitment as being medically necessary. The majority affirms that decision. It concludes the evidence was sufficient to support the commitment, because M.A.C. posed a threat of harm to himself. For the reasons that follow, I respectfully dissent.
In his first issue, M.A.C. challenges the sufficiency of the evidence to support his involuntary commitment under the Mental Health Procedures Act (MHPA), 50 P.S. §§ 7101-7502. Significantly, to support an involuntary commitment under section 302 of the MHPA, there must be sufficient evidence that the patient posed a clear and present danger to others or himself as outlined in section 301 of the Act. 50 P.S. §§ 7301(b), 7302(b).
Regarding danger to others, the MHPA requires evidence that within the past 30 days: "the person has inflicted or attempted to inflict serious bodily harm on another and that there is a reasonable probability that such conduct will be repeated." 50 P.S. § 7301(b)(1). Alternatively, a clear and present danger of harm to others may be demonstrated by proof "that the person has made threats of harm and has committed acts in furtherance of the threat to commit harm." Id.
There is a third basis to support a finding of clear and present danger to others not relevant here. Namely, when the person has been found incompetent to be tried or has been acquitted by reason of lack of criminal responsibility on charges arising from conduct involving infliction of or attempt to inflict substantial bodily harm on another. 50 P.S. § 7301(b)(1). In such cases, the statute provides that the 30-day limitation shall not apply so long as an application for examination and treatment is filed within 30 days after the date of such determination or verdict. Id. In such case, a clear and present danger to others may be shown by establishing that the conduct charged in the criminal proceeding did occur, and that there is a reasonable probability that the conduct will be repeated. Id.; see also Commonwealth v. Helms, 506 A.2d 1384, 1388-91 (Pa. Super. 1986).
Regarding danger of self-harm, the MHPA requires evidence that within the past 30 days one of the following three scenarios occurred:
(i) the person has acted in such manner as to evidence that he would be unable, without care, supervision and the continued assistance of others, to satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety, and that there is a reasonable probability that death, serious bodily injury
or serious physical debilitation would ensue within 30 days unless adequate treatment were afforded under this act; or
(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 furtherance of the threat to commit suicide; or
(iii) the person has substantially mutilated himself or attempted to mutilate himself substantially and that there is the reasonable probability of mutilation unless adequate treatment is afforded under this act. For the purposes of this subsection, a clear and present danger shall be established by proof that the person has made threats to commit mutilation and has committed acts which are in furtherance of the threat to commit mutilation.50 Pa.C.S.A. § 7301(b)(2).
If a physician determines that a patient poses a threat of harm to himself or others and needs treatment, the criteria for involuntary commitment under section 302 are met, and treatment may be started immediately. Id. at § 7302(b).
Preliminarily, as the majority notes, our standard of review for a sufficiency challenge of a 302 commitment is de novo. In re Vencil, 152 A.3d 235, 246 (Pa. 2017). Our Supreme Court stated:
under section 6111.1(g)(2), a challenge to the sufficiency of the evidence to support a 302 commitment presents a pure question of law, and the court's sole concern is whether, based on the findings recorded by the physician and the information he or she relied upon in arriving at those findings, the precise, legislatively defined prerequisites for a 302 commitment have been satisfied and are supported by a preponderance of the evidence.Id. (emphasis added).
The MHPA does not provide specifically for a direct appeal to a 302 commitment. However, it provides generally that "Actions requesting damages, declaratory judgment, injunction, mandamus, writs of prohibition, habeas corpus, including challenges to the legality of detention or degree of restraint, and any other remedies or relief granted by law may be maintained in order to protect and effectuate the rights granted under this act." 50 P.S. § 7113. Additionally, as M.A.C. does here, a 302 commitment can be challenged after the fact by filing a petition to expunge the record, under the Uniform Firearms Act, 18 Pa.C.S.A. § 6111.1(g)(2). The pertinent part of this statute provides:
A person who is involuntarily committed pursuant to section 302 of the Mental Health Procedures Act may petition the court to review the sufficiency of the evidence upon which the commitment was based. If the court determines that the evidence upon which the involuntary commitment was based was insufficient, the court shall order that the record of the commitment submitted to the Pennsylvania State Police be expunged.18 Pa.C.S.A. § 6111.1(g)(2).
The scope of review for both the trial court and the appellate court is limited to the findings recorded by the physician and the information he or she relied upon in arriving at those findings. Id. There is no judicial record of the 302 decision for the courts to review. Id. at 244. The examining doctor acts as the factfinder to determine whether there are sufficient facts to indicate that patient is severely mentally disabled and in need of treatment. See 50 P.S. § 7302(b) ("A person taken to a facility shall be examined by a physician within two hours of arrival in order to determine if the person is severely mentally disabled within the meaning of section 301(b)1 and in need of immediate treatment."). The MPHA requires the physician to "make a record of the examination and his findings." Id. "If it is determined that the person is severely mentally disabled and in need of emergency treatment, treatment shall be begun immediately." Id. Based on this procedure, the only record to review from a 302 commitment is the physician's written record of his or her examination and findings. Vencil, 152 A.3d at 244.
The courts are not involved in the emergency application for treatment under 302; instead, under the MHPA, the application is filed with the County Mental Health Administrator or his/her delegate, who reviews the application and, if approved, issues a warrant to transport the patient to a hospital or treatment facility for evaluation. 50 P.S. § 7302(a)(1). Alternatively, upon personal observation of Section 301 behavior, any physician, police officer or other authorized person may have the patient transported to an approved facility for examination without a warrant. 50 P.S. § 7302(a)(2).
The court only becomes involved in an involuntary commitment if the patient requires treatment beyond the initial 120-hour period authorized by section 302. Prior the expiration of 120 hours, if the patient does not agree to continued voluntary treatment under section 202, the facility must file a section 303 certification with the court of common pleas. 50 P.S. §§ 7302(d), 7303(a).
"Upon receiving such application, the court of common pleas shall appoint an attorney who shall represent the person unless it shall appear that the person can afford, and desires to have, private representation. Within 24 hours after the application is filed, an informal hearing shall be conducted by a judge or by a mental health review officer [MHRO] and, if practicable, shall be held at the facility."50 P.S. § 7303 (b).
At the conclusion of the review, if the judge or the review officer finds that the person is severely mentally disabled and in need of continued involuntary treatment, either as an inpatient or through less restrictive assisted outpatient treatment, he shall so certify. Otherwise, he shall direct that the facility director or his designee discharge the person."50 P.S. § 7303(c)(1). The MPHA requires section 303 hearings to be recorded, and the recording to be kept for one year. 50 P.S. § 7303(c)(2). It further lists the documents that must be included in the certification. 50 P.S. § 7303(d). If the section 303 hearing occurred before a MHRO, the person may petition for review of the certification by the court of common pleas, and a hearing must be held within 72 hours. 50 P.S. § 7303(g). A 303 commitment authorizes treatment for an additional 20 days, after which a similar process may be followed under section 304 to authorize an additional 90 days of treatment (or up to one year in some circumstances). 50 P.S. 7303(h), 7304 (a)-(g). If continuing treatment is required beyond those 90 days, section 305 allows the court, upon application and a hearing, to order additional treatment periods in 180-day intervals. 50 P.S. § 7305 (a)-(c).
Finally, as with any sufficiency challenge, we must review the facts of record in the light most favorable to the original decision maker or prevailing party (if applicable) to determine whether the requisite standard has been met. Id. at 243. Deference to the facts as found by the original factfinder is of particular importance where the factfinders have specialized training or knowledge that makes them uniquely qualified to reach the findings and conclusions the General Assembly has entrusted them to make. Id. For a 302 commitment, courts review the facts in the light most favorable to the physician, as the original factfinder, "who examined and evaluated the individual in the first instance, was able to observe his or her demeanor, and [who] has particularized training, knowledge and experience regarding whether a 302 commitment is medically necessary." Id. at 246.
By way of additional background, an application for a 302 commitment must be made on a form issued and approved by the Pennsylvania Department of Human Services. 55 Pa. Code § 5100.23. The standard form for a 302 Application is seven pages and has six parts. See Form MH-781-A. Only Parts I and VI are relevant to this type of sufficiency challenge.Part I is completed by the petitioner, who makes the initial request to have a patient involuntarily committed for evaluation and treatment. The first line of this part requires the petitioner to identify the patient whom the petitioner believes is severely mentally disabled. The form provides four possible boxes for the petitioner to check to indicate how the patient poses a clear and present danger to others or himself/herself and instructs the petitioner to check all boxes that apply. There is one box to allege harm to others and three boxes to allege self-harm.
Part II is completed when transporting the patient to a medical facility without a warrant from the County Administrator and may be used in emergency situations when the Administrator or his/her delegee gives approval by phone. Part III is the Warrant. This is completed by the County Administrator after reviewing Part I of the petition; if the warrant issued, it authorizes the patient to be transported against their will to a designated facility to be examined and if necessary, to be admitted for up to 120 hours. (Neither Parts II nor Part III is necessary when a physician or police officer personally observes the 301 behavior; in such situations, those individuals check Box B on Part I of the form, arrange transportation by ambulance, police car, or other means, and directly request the facility to examine the patient. See footnote 4, supra). Part IV verifies that the patient was informed of his or her legal rights as described in Form MH 783-A. Part V identifies actions taken to assure that while the patient is detained, the health and safety needs of any of his/her dependents are met and that his/her personal property and the premises he/she occupies are secure.
The three boxes for self-harm set forth the criteria outlined in section 301(b)(2), set forth supra.
On the next page, the form provides space to document the behavior necessitating the Application. A supplemental page is also available if the petitioner needs more space. The form directs the petitioner to "Describe in detail the specific behavior within the last 30 days which supports your belief (include location, date and time whenever possible, and state who observed the behavior)." Id.
Part VI of the Application is completed by the examining physician. The form provides a space for the physician to document his or her findings. It states, "Describe your findings in detail. Use additional sheets if necessary." Id.
Turning to the 302 Application that M.A.C. challenges in this case, Part I was completed by police officer Donald E. Myers, Jr., who, within a two-hour period, twice responded to calls for help apparently made by M.A.C. Officer Myers only checked the box on the form indicating he believed M.A.C. posed a clear and present danger to others. Notably, the officer did not check any of the three boxes indicating a belief that M.A.C. posed a threat of harm to himself.
In the narrative portion of the Application, Officer Myers wrote:
I was dispatched to the residence for persons inside residence. After checking exterior, then entrance, and finding nothing, it was found the subject hasn't slept in [three] days and hearing voices. Subject had HDAD [sic], and very paranoid. House complete mess, doors and stairways barricaded with furniture. Responded two hours later. Still hearing voices and suspect inside residence. After negotiating for 45 [minutes], finally made entry, and once again found nothing. Kitchen area completely filthy with dirty dishes and pots over a week old. Found approximately 20 cases
of water and 10 to 15 emergency meal buckets about the house. Due to the individual, barricading exits with furniture, the children, [seven]-year-old boy, [eight]-year-old girl, would not be able to exit residence. At one point [the] children were locked inside a bedroom closet. While [Children and Youth Services] caseworkers were speaking with a [M.A.C.], the [seven-year-old] boy nearly knocked the couch onto himself.Application for Involuntary Emergency Examination and Treatment, 4/1/22, at 2-3.
At the expungement hearing, counsel for M.A.C. indicated he believed the word on the form was rocked, not knocked. The form is hand-written, and some words are difficult to read.
Part VI of the Application was completed by the Emergency Room Physician, Dr. Alyssa Tomsey, who examined M.A.C. at Butler Memorial Hospital. When asked to describe her findings in detail, Dr. Tomsey wrote on the first line: "Paranoid" and on the second line: "Auditory Hallucinations." Id. at 7. Dr. Tomsey did not identify or describe any actual harm, attempted harm, or threats of harm to others by M.A.C.
In his expungement petition, M.A.C. claims that this evidence was is insufficient to support a 302 commitment. I agree. I believe the doctor's factual findings in this Application fall woefully short of "the legislatively defined prerequisites for a 302 commitment." Vencil, 152 A.3d at 246. There are simply no allegations from the petitioning police officer and no observations by the examining doctor to indicate that M.A.C. inflicted or attempted to inflict any serious bodily harm or that he made threats of harm to others.
The only issues the policeman documented were that the "house [was a] complete mess" and the "kitchen was completely filthy with dirty dishes and pots over a week old." But a dirty house does not warrant a 302 commitment. The officer also noted an unusual amount of emergency food and water were present. Again, people are free to stockpile food and water. Finally, the officer documented that the exits were blocked with furniture such that the children could not exit; and at one point the children were locked inside a bedroom closet. These facts are certainly abnormal and may have raised questions concerning the safety of the children, which justified Children and Youth Services being called to investigate. However, these facts do not indicate that M.A.C. inflicted harm, attempted to harm, or threatened serious bodily harm to his children or anyone else, which is required to support a 302 commitment.
The MHPA and our caselaw require more than general findings of paranoia and auditory hallucinations. At a minimum, where there is no actual or attempted physical harm, a 302 commitment requires facts that indicate a credible threat of harm and an act in furtherance of that threat. See In re B.W. 250 A.3d 1163, 1175 (Pa. 2021).
In B.W., for example, our Supreme Court upheld a 302 commitment where a person made credible threats of harm against a co-worker. B.W. went to his primary care physician because he was experiencing anxiety and made threats of violence against a co-worker. Id. at 1168. During his examination of B.W., the doctor initiated a 302 Application and completed Part I of the form. As the petitioner, the doctor checked the box indicating he believed BW was severely mentally disabled, because he posed a clear and present danger to others. Id. In the narrative portion of the form, the petitioning doctor described the following details that supported his belief: "I, Dr. Sumereau, was present, while the patient stated that he would strangle another person to death. He then gave the name of the intended victim. Patient stated that he was not sure when or where he would perform this act, but he would do it the next time he saw the person." Id. (citing the Application for Involuntary Emergency Evaluation and Treatment, 9/6/18, at 3).
B.W. was then transferred to the hospital, where the examining physician filled out Part VI of the 302 Application. In describing her findings, the physician noted, "[B.W.] is homicidal toward his coworker, and admits to stating that he would strangle him. B.W. is very angry and agitated, danger to others. Not receptive to voluntary admission." Id. (citing the 302 Application at 7). The examining doctor recommended admission to the facility for up to 120 hours of treatment. B.W. was admitted and released after 72 hours. Id.
A few weeks later, B.W. filed a petition to expunge his mental health record. Although he did not cite Section 6111.1(g)(2), the court treated the petition as such. Id. at 1168-69. Following a hearing, the trial court denied B.W.'s request. Applying the Supreme Court's holding in Vencil, the trial court found "that the evidence known by the physician at the time, as contained in the contemporaneously-created record, supports the conclusion that [B.W.] presented a clear and present danger to others, requiring a 302 commitment." Id. at 1169.
The Superior Court reversed, because although B.W. made a threat against the co-worker, "the threat itself, without more does not constitute an act in furtherance of the threat." Id. at 1170.
The Supreme Court reversed the Superior Court. First, it agreed that proof of an act in furtherance of the threat to commit harm was necessary for a 302 commitment. Id. at 1175. However, it concluded that engaging in the planning process by conducting research or expressing a detailed plan constitute acts in furtherance of a threat under the MHPA. Id. at 1176. In examining the actions of B.W., the High Court observed that "B.W. articulated to his physician a developed, specific plan to kill his co-worker, whom he identified, by strangling him the next time he saw him. This plan was fully formed as it detailed the named target of the threat, the method of carrying out the threat of harm, and the imminence of the threat." This was sufficient proof of an act in furtherance of the threat. Id. Significantly, the court also observed that the "physicians who treated B.W. found his threats credible and determined that B.W. was in need of immediate treatment." Id.
The Court clarified that an act in furtherance of a threat to harm another person is not necessary for all involuntary commitments. Id. at 1175. Earlier in the opinion the court observed that there are three alternative means of establishing a clear and present danger to others. See id. at 1173.
Here, by contrast, the police officer and the examining physician did not document that M.A.C. made a threat of harm to his children or anyone else. There are no facts that within the past 30 days, M.A.C. "inflicted or attempted to inflict serious bodily harm on another and that there is a reasonable probability that such conduct will be repeated." 50 P.S. § 7301(b)(1). Additionally, there are no facts that M.A.C. "has made threats of harm and has committed acts in furtherance of the threat to commit harm." Id. As such, the record does not contain sufficient evidence to support a finding that M.A.C. posed a threat of harm to others.
Notwithstanding that the petition only alleged M.A.C. posed a threat of harm to others, the majority opines that the evidence was sufficient to show that M.A.C. posed a threat of harm to himself. Initially, majority concludes the examining doctor is not bound by the box checked by the petitioner, but instead, is free to determine whether the patient poses a clear and present danger of harm to others or to himself under any applicable sections of the MPHA. Majority at *9. I agree. Section 302(b) of the MHPA provides that the physician shall examine the patient "to determine if the person is severely mentally disabled within the meaning of section 301(b)." 50 P.S. §7302. Because section 301(b) encompasses (b)(1) (harm to others) and (b)(2)(i)-(iii) (harm to self), the physician's examination extends to all parts of 301(b), and is not limited to the box(es) checked in Part I of the Application.
The majority then concludes that the evidence here was sufficient to support the conclusion that M.A.C. posed a threat of harm to himself. Majority at *9-10. On this point, I disagree. Neither the police officer nor the doctor indicated that M.A.C. posed a threat of harm to himself. Aside from "paranoid" and "auditory hallucinations," the doctor made no other findings.
Somehow the majority reads into these three words that the criteria for the first scenario of self-harm under section 301(b)(2)(i) of the MPHA were met, i.e. that M.A.C. "would be unable, without care, supervision and the continued assistance of others, to satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety, and that there is a reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within 30 days unless adequate treatment were afforded" under this Act. Majority at *10. I cannot make this leap.
The serious deprivations of liberty authorized by the MHPA demand that such deprivations be justified through strict compliance with statute's substantive and procedural requirements. In re S.M., 176 A.3d 927, 939 (Pa. Super. 2017). Considering both Parts I and VI of the 302 application (which is all the evidence we have to conduct our de novo review), nothing indicated that M.A.C. suffered from a lack of nourishment, hydration, or shelter. Nothing indicated that M.A.C. was neglecting serious medical treatment, or that he was unable to safely complete the activities of daily living, e.g. cooking without starting a fire. See e.g. In re S.B., 777 A.2d 454, 458 (Pa. Super. 2000) (section 301(b)(2)(i) met where patient refused to take her medication for depression and anxiety; refused meals; her hygiene was poor; and she was unable to approach the staff for help if she felt suicidal). The doctor did not identify any life-threatening safety risks that would necessitate immediate medical intervention. The doctor did not indicate that M.A.C.'s blocking doors or stairs posed a "risk of harm to self," such that "death, serious bodily injury or serious physical debilitation would ensue within 30 days" if treatment was not provided, as required under the MPHA. 50 P.S. §7301(b)(2)(i). On my review of the record before us, I cannot conclude that M.A.C.'s behavior met the requirements for an involuntary commitment under the MPHA.
Whether it would be good public policy to allow the commitment of individuals who are paranoid and hearing voices, without more, is not this Court's place to say; regardless, the legislature unmistakably required more. See In re B.W., 250 A.2d at 1179 (Todd, C.J. dissenting, noting it is not the courts' place to decide public policy regarding involuntary commitments).
While I do not believe an examining doctor needs to use the precise language set forth in the MHPA, the doctor must detail his or her factual findings on Part VI of the 302 Application with enough specificity to identify the 301 behavior at issue. These findings must identify some actual or attempted serious bodily harm committed by the patient; observations of credible threats of harm; or examples of behavior to show why the patient cannot satisfy their personal needs such that death, serious bodily injury, or serious physical debilitation will ensue if not treated promptly. See, e.g., In re J.G.F., 295 A.3d 265, 272 (Pa. Super. 2023) (upholding 302 commitment where doctor found patient "to be 'delusional,' 'paranoid,' and a 'potential harm to others as he threw urine at staff and [was] physically and verbally abusive.'") (emphasis added). See also B.W., 250 A.3d at 1168 (upholding 302 commitment where doctor wrote that the patient was "homicidal toward his coworker, and admits to stating that he would strangle him," and the patient was "very angry and agitated, danger to others."); In re R.F., 914 A.2d 907, 911 (Pa. Super. 2006) (upholding 302 and 303 commitment where petitioning officer indicated that appellant called crisis hotline, asked them how to commit suicide because he wanted to get it right, told them not to send anyone because they would not get inside, and stated he has a loaded rifle and he is going to use it, and examining physician noted "suicidal ideations" and appellant needed "protection from self" on 302 Application); Commonwealth v. Smerconish, 112 A.3d 1260, 1264, 1267 (Pa. Super. 2015) (upholding 302 commitment where trial court relied only on the 302 paperwork that indicated appellant sent his sister twelve instant messages about committing suicide and researched painless ways of committing suicide on internet).
I also believe the petitioner should identify with particularity the behaviors necessitating the need to seek an involuntary commitment on Part I of the 302 Application. See, e.g., B.W., 250 A.3d at 1168) (where the petitioning doctor wrote on Part I that he "was present while patient stated he would strangle another person to death" the next time patient saw the person, and patient gave the name of the intended victim.) Such details give the examining doctor background information to use in his or her examination of the patient when assessing whether a 302 commitment is necessary.
In sum, the record before us is completely devoid of any evidence that M.A.C. posed "a clear and present danger to himself or others" as those terms are defined by the MPHA. Although I believe M.A.C. voluntarily should have sought treatment for his mental health conditions, this is a separate question from whether he met the requirements for involuntary treatment under the MHPA. Because I do not believe the evidence supported an involuntary commitment, I dissent.
Because I would grant relief on M.A.C.'s first appellate issue, I make no comment on his remaining two issues.