Trial News

The Pennsylvania Supreme Court has held that a qualified immunity provision for providers under the state’s Mental Health Procedures Act does not apply when a patient is admitted for and is primarily receiving substance abuse treatment and when that patient did not receive treatment for a mental illness. A previous history of mental illness is not adequate to confer immunity if treatment is not being administered to facilitate recovery from mental illness. (Dean v. Bowling Green-Brandywine, 2020 WL 808938 (Pa. Feb. 19, 2020).)

Andrew Johnson admitted himself to the Bowling Green-Brandywine Addiction Treatment Center for dependence on prescription drugs stemming from injuries he suffered in an ATV crash. In the admission paperwork, Johnson noted that in the past he had been diagnosed with bipolar disorder and ADHD but that he was not under the care of a mental health professional nor was he taking any medications for mental health issues. He was examined by a doctor and placed on a detoxification program, including a methadone taper.

Four days later, Johnson complained of being unable to see and move and was transported to a hospital emergency room. The ER doctor determined that he was experiencing symptoms of withdrawal and released him back to the treatment center. Twelve hours later, Johnson was found unresponsive in his room and was taken back to the ER, where he was again diagnosed with withdrawal symptoms. The treatment center then performed a psychiatric evaluation, noting that he was not on medication for mental health issues; that he hadn’t seen a psychiatrist in many years; and that he was reporting anxiety symptoms, for which the psychiatrist prescribed an anti-anxiety medication.

The following day, treatment center staff noted that Johnson’s blood pressure and heart rate were elevated. The center’s doctor refused to examine him or provide any instructions for treatment. Staff continued to check on Johnson, who still had elevated vital signs, but they did not provide any treatment. He was found unresponsive in his room the next morning and pronounced dead at the hospital.

Johnson’s parents filed medical negligence and wrongful death claims against the treatment center and the doctors involved. They alleged that Johnson died from cardiac arrhythmia caused by the medication the treatment center prescribed for his drug detoxification and that the defendants failed to properly treat Johnson after his symptoms presented.

The doctors all asserted qualified immunity under the Pennsylvania Mental Health Procedures Act, which immunizes mental health providers from liability unless there was willful misconduct or gross negligence. The plaintiffs argued that qualified immunity did not apply because Johnson was being treated for substance use, not a mental illness.

The trial court found that the immunity provision applied because Johnson’s previous history of bipolar disorder was noted in his file, he had previously taken medication for mental illness, and a psychiatric evaluation had occurred at the facility after he exhibited symptoms such as hallucinations. The appellate court affirmed, and the plaintiffs appealed.

The Pennsylvania Supreme Court looked at how the statute defines “examined or treated,” noting that the statute focuses on recovery from mental illness. According to state health department guidance for implementing the statute, drug dependence in and of itself is not a mental illness, while it also does not preclude the co-presence of a mental illness. The court summarized that “to be entitled to immunity, [defendants] must have provided treatment for a mental illness, independent from and in addition to the treatment provided for Andrew’s ‘drug dependence.’” Immunity does not automatically apply simply because a patient has a history of mental illness, but it applies to treatment decisions that supplement or facilitate recovery from mental illness.  

Applying this standard to Johnson, the court concluded that his treatment was not to facilitate recovery from mental illness. The record clearly established that he entered the facility for substance abuse treatment and that the treatment the facility provided was specifically for detoxification from drug use. His ER visits were directly related to withdrawal and his reaction to the detoxification treatment, and there was nothing in the records that indicated he was receiving mental health treatment at the facility. The anti-anxiety medication he was prescribed at the facility was related to his withdrawal symptoms, not to address a mental illness. Johnson’s self-reported history of bipolar disorder and ADHD were not sufficient to claim he was being treated for mental illness, and there was no evidence that his elevated vital signs were related to any mental illness treatment.

The court noted that finding otherwise “would essentially immunize all providers that adopt a routine practice of ordering a ‘psychiatric consult’ for every patient, regardless of presentation,” and it reversed the lower court.

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