SOURCE: American Medical Association

Giving mental health patients access to outpatient care and reserving involuntary commitments for situations that warrant them is crucial to patient safety because studies show that involuntarily commitments result in patients refusing help for fear their civil rights will be taken away.

State laws over decades have evolved to support physicians in striking that balance. Now a plaintiff is asking Pennsylvania’s highest court to interpret a commonwealth law in a way that would ultimately force physicians who feared being sued to err on the side of providing involuntarily treatments for patients to whom they otherwise would have provided voluntarily outpatient care.

The Litigation Center of the American Medical Association and State Medical Societies in December joined the Pennsylvania Medical Society and the Pennsylvania Psychiatric Society in filing an amicus brief in the matter. The brief asks the Supreme Court of Pennsylvania to uphold an appellate court decision that does not open physicians up to a new liability when they are making treatment decisions involving mental health patients.

“Overall, studies have shown that 77% of previously admitted patients will not risk being institutionalized again, even if they know they pose a danger to themselves or others. Creating a liability system that would incentivize involuntary commitment, which a liability ruling here would do, would have larger repercussions,” the brief tells the court in the case, Leight v. University of Pittsburgh Physicians, et al.

A ruling opening up doctors to new liability would result in physicians involuntarily committing more patients out of fear of lawsuits. That would not improve mental health care, the brief states, and would raise costs while creating greater risks for patients and the public as a whole. One in five adults experiences a mental illness at some point, and one in 25 is living with a serious mental illness.
An attempt to expand liability

The lawsuit before the court stems from a 2012 mass shooting in the outpatient lobby of the Western Psychiatric Institute and Clinic (WPIC) in Pittsburgh. WPIC receptionist Kathryn Leight sued after outpatient John Shick shot her and several other people.

She and her husband are seeking damages from the University of Pittsburgh Physicians and University of Pittsburgh of the Commonwealth System of Higher Education and their physicians because the doctors decided against involuntarily committing Shick.

The physicians, the AMA Litigation Center brief says, are not liable under traditional liability law: Physicians considered whether Shick was a candidate for involuntarily commitment, but after a clinical examination never found that he met that criteria. Shick never expressed suicidal or homicidal ideations and denied having them during examinations, court documents show. Physicians never found he presented an immediate threat, or that Leight was an identified or readily identified target.

Instead, even though the physicians only provided voluntary care to Shick, Leight is looking to proceed with a lawsuit that seeks damages under the Mental Health Procedures Act (MHPA), which provides physicians who treat mentally ill patients with limited immunity in cases of involuntary treatments.

The law is in place to “assure the availability of adequate treatment to persons who are mentally ill.” It does not extend the additional protections to physicians who act with “willful misconduct or gross negligence.” The Leights say if they can trigger MHPA and show the physicians acted with gross negligence, the physicians would be subject to liability.

The AMA Litigation Center brief tells the court they should not allow the lawsuit to go forward because the physicians only provided Shick with voluntary outpatient care, which means the MHPA doesn’t apply. The Leights, the brief says, are presenting the court with “a legally incongruous proposition: they are attempting to trigger a statute that provides defendants with immunity in order to sue them. … If the court allows this case to proceed it would turn the MHPA on its head.”

Beyond that, the brief concludes, “expanding the scope of liability of health care professionals would strain the mental health care system by increasing the costs of patient care. Here, creating liability may result in compensation to Ms. Leight and her family, but it will not lead to a safer community or better mental health care. It could very easily have the opposite effect, putting more patients and others at greater risk.”