In re G.M.

287 A.3d 859 (Table)

IN RE: G.M.

Appeal of: G.M.

No. 1693 MDA 2021

Superior Court of Pennsylvania.

Filed October 13, 2022

MEMORANDUM BY STABILE, J.:

Appellant, G.M., appeals from the December 3, 2021 order affirming a ten-day extension of her involuntary commitment pursuant to the Mental Health Procedures Act ("MHPA"), 50 P.S. §§ 7302 and 7303. We reverse.

The record reveals that Appellant was involuntarily committed, pursuant to 50 P.S. § 7302,¹ to Haven Behavioral Hospital ("Haven") on November 27, 2021. On November 30, Haven filed a petition to extend Appellant's commitment pursuant to 50 P.S. § 7303.² At the conclusion of a December 1, 2021 hearing before a Mental Health Review Officer ("MHRO"), Appellant's commitment was extended for ten days. On December 2, 2021, Appellant filed a petition for review before the Berks County Court of Common Pleas. Pursuant to Appellant's request, the trial court reviewed the audio recording of the December 1, 2021 hearing before the MHRO, and issued an order affirming the extension of Appellant's commitment. This timely appeal followed.

Appellant argues that Haven failed to present sufficient evidence in support of the Section 303 extension because Appellant's treating psychiatrist—Haven's sole witness at the December 1, 2021 hearing—failed to explain how Appellant posed a clear and present danger to herself or others. Appellant's Brief at 4.³ After careful consideration, we agree.

Section 7301 ("Section 301") of the Mental Health Procedures Act ("MHPA") provides for the involuntary commitment of persons severely in need of help. It provides, in relevant part:

(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 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, as defined in subsection (b), or the person is determined to be in need of assisted outpatient treatment as defined in subsection (c).

(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:

(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 [.]

50 P.S. § 7301 (emphasis added).

In essence,

The MHPA provides for involuntary emergency examination and treatment of persons who are "severally mentally disabled and in need of immediate treatment." 50 P.S. § 7301(a). It then authorizes increasingly long periods of commitment for such persons, balanced by increasing due process protections in recognition of the significant deprivations of liberty at stake. See In re A.J.N. , 144 A.3d 130, 137 (Pa. Super. 2016) (highlighting MHPA's purpose as "an enlightened legislative endeavor to strike a balance between the state's valid interest in imposing and providing mental health treatment and the individual patient's rights") (quoting In re Hutchinson , 454 A.2d 1008, 1010 (Pa. 1982) ); In re Ryan , 784 A.2d 803, 807 (Pa. Super. 2001) ("The legislative policy reflected in the [MHPA] is to require that strict conditions be satisfied before a court order for commitment shall be issued. Such a policy is in accord with the recognition that commitment entails a massive deprivation of liberty.") (quoting Commonwealth v. Hubert , 494 Pa. 148, 430 A.2d 1160, 1162 (1981) ). Accordingly, "[i]n applying the [MHPA,] we must take a balanced approach and remain mindful of the patient's due process and liberty interests, while at the same time permitting the mental health system to provide proper treatment to those involuntarily committed to its care." In re S.L.W. , 698 A.2d 90, 94 (Pa. Super. 1997).

In re S.M. , 176 A.3d 927, 930-31 (Pa. Super. 2017).

"[I]n reviewing a trial court order for involuntary commitment, we must determine whether there is evidence in the record to justify the court's findings." Id. at 935.

The burden is on the petitioner to prove the requisite statutory grounds by clear and convincing evidence. Our Supreme Court has defined clear and convincing evidence as testimony that is so clear, direct, weighty, and convincing as to enable the trier of fact to come to a clear conviction, without hesitation, of the truth of the precise facts in issue. [T]he clear and convincing evidence test ‘has been described as an intermediate test, which is more exacting than a preponderance of the evidence test, but less exacting than proof beyond a reasonable doubt. Where a mental health review officer has made a recommendation, the trial court is to conduct a de novo review of that determination.

Id. at 937 (internal citations and quotation marks omitted).

In S.M. , the patient argued the "County merely showed that her treating physician's major concern was her ‘resistance to taking her psychiatric medications at the prescribed level,’ and that no one testified " ‘that a decrease in the dosage of [her] medication, or even the complete cessation of it, would cause withdrawal symptoms of such magnitude as to threaten serious bodily injury.’ " Id. at 935. Additionally, she asserted that "the County's evidence—that in December 2015, she went several days without eating, went several nights without sleep, and made racial slurs to other residents"—failed to show by clear and convincing evidence that she posed a clear and present danger to herself. Id. at 935. In reviewing the sufficiency of the evidence in support of her commitment,⁴ this Court wrote:

At the MHRO hearing, the treating psychiatrist's primary complaint was that S.M. was not taking her medication in therapeutic doses. While the psychiatrist did testify that S.M. has a severe mental illness, specifically a schizoaffective bipolar disorder, the only symptoms he described were that S.M. believed (1) that her disease was better treated through homeopathic remedies rather than allopathic medicine, and (2) various hospital and state officials were conspiring and colluding with her mother to keep her involuntarily committed. While the treating psychiatrist did testify that her illness and unwillingness to take her medication in therapeutic doses affected her judgment, he did not testify that S.M. posed a danger to herself or that there was a reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within 30 days unless adequate treatment were afforded. Instead, the essence of his testimony was that S.M. would be better off taking her medications in therapeutic doses, and that the best way to ensure that she did so was through continued involuntary commitment.

Id. at 938–39 (record citations omitted). Likewise, this Court concluded that the patient's periodic refusal of food and her inability to sleep did not justify an extended commitment. Id. at 939. We therefore reversed the order affirming the patient's commitment.⁵

In Commonwealth ex rel. Gibson v. DiGiacinto , 439 A.2d 105 (Pa. 1981), our Supreme Court review the extended voluntary commitment of a patient who, while in county prison for criminal mischief and criminal trespass, was diagnosed with schizophrenia and paranoid delusions. Id. at 106. On one occasion, a corrections officer found the patient extinguishing a burning newspaper in his cell. On another occasion, the patient was found in possession of a twisted piece of coat hanger apparently intended as a weapon. Id. The Supreme Court found no sufficient evidence that the patient was a clear and present danger to himself. The burning newspaper was not evidence of an attempt at self-harm, as the patient was permitted to smoke and there was no evidence the newspaper was intentionally lit on fire. Id. at 107. As to the twisted coat hanger, there was no evidence that the patient used or threatened to use it to harm himself or others. Id. Finally, there was no evidence that the patient's behavior changed as a result of occasional noncompliance with his medication. Id.

Instantly, the recording of the December 2, 2021 hearing before the MHRO reveals that Dr. Ramesh Eluri, Appellant's treating psychiatrist, testified that Appellant was treated at Haven approximately a week prior to the stay currently at issue; she was discharged with a diagnosis of bipolar disorder. N.T. Hearing, 12/2/21, at 1:00-1:15.⁶ He saw her daily (three days in succession) during the most recent § 7302 admission. Id. at 5:37-48. Appellant was compliant with her medication. Id. at 5:48-5:53. She was able to meet her daily living needs while staying at Haven. Id. at 6:30-6:39. Appellant did not show any aggressive or assaultive behavior toward others while at Haven. Id. at 6:43-6:54. Nonetheless, she needed lots of redirection from the staff at Haven. Id. at 3:40-3:42.

Dr. Eluri testified that Appellant presents with "hyberverbosity, pressured speech, flight of ideas, looseness of association, grandiosity, paranoid delusions, and hyperactivity." Id. at 2:37-2:51. Appellant believed her son was "head of mass destruction" for the United States Navy, and because of Appellant's § 7302 commitment "he's going to do that." Id. at 1:40-1:50. Appellant believed she was raped by five people while staying at another hospital. Id. at 1:53-2:08. Dr. Eluri testified that Appellant believed the reason for the present admission under § 7302, was that she was accused of stealing forty pumpkin pies. Id. at 2:13-2:20. Appellant claimed sh...