The Pennsylvania Supreme Court is set to decide whether a law granting immunity to health care providers who treat mental illness should have been applied to a drug addiction treatment facility and its two physicians who treated a man while he was suffering from an opioid addiction.

In July of last year, a three-judge Superior Court panel determined that the two doctors who treated the man after he was transferred from the drug treatment facility should not have been afforded liability protections under the Mental Health Procedures Act. The ruling reversed a decision by the Chester County Court of Common Pleas, but affirmed the lower court's additional holding that the drug treatment facility and its two physicians should be granted immunity under the MHPA.

It's that latter portion of the appellate panel's ruling that is now the subject of an appeal before the Supreme Court.

According to the Superior Court's opinion, penned by Judge Jack Panella, when plaintiff Andrew Johnson was 23 he voluntarily applied to be admitted to the Bowling Green Brandywine Treatment Center to treat his addiction to opiates and benzodiazepines that he had initially been prescribed to treat injuries related to an ATV accident. He made two trips to the emergency room during his stay after he allegedly began hallucinating. Ten days after he was admitted to the facility, he was found unresponsive on the floor of his room. He died soon after.

Johnson's parents sued emergency room physicians James Duncklee and Jennifer Plumb, along with their practice, as well as the treatment facility and its psychiatrist and doctor, both of whom treated Johnson as well. The case went to trial, but the judge eventually granted nonsuit, finding that the plaintiffs failed to show that any of the defendants had been grossly negligent.

On appeal, the Superior Court agreed with the trial judge that Dr. Asim Khurshid Rana, Brandywine's psychiatrist, was covered under the MHPA.

“Dr. Rana diagnosed Johnson 'with mood disorder, anxiety disorder, et. cetera, [and] opioid substance abuse induced mood,'” Panella said. ”As a result, he started treating Johnson with Neurontin, which can be used to treat bipolar disorders. Thus, by appellants' own evidence, Dr. Rana was engaged in the 'diagnosis, evaluation, therapy, or rehabilitation' of mental illness in Johnson. The trial court did not err in concluding Dr. Rana was covered by the limited immunity provided by the MHPA.”

The Superior Court also upheld the judge's findings that limited immunity applied to the Brandywine facility and its physician, Dr. Mohammad Ali Khan.

“They were caring for Johnson both before and after Dr. Rana's psychiatric consult,” Panella said. “As discussed, there is no evidence Johnson was being treated for mental illness prior to Dr. Rana's consult. Furthermore, we conclude that, due to Dr. Rana's diagnosis and treatment of Johnson's mental illness, Dr. Khan and Brandywine's actions after the psychiatric consult are covered by the limited immunity provisions of the MHPA.”

With that in mind, the appellate panel set about to determining whether the plaintiffs' claims against Khan and Brandywine were based on circumstances that arose after Rana's consult.

The panel found that that the testimony of Dr. George Glass, the plaintiffs' standard of care expert, with regard to Khan's alleged negligence centered primarily on the defendant doctor's decision not to transfer Johnson to the emergency room the night before he died.

“Thus, Dr. Glass opined that the causative breach of Dr. Khan's standard of care occurred after the psychiatric consult,” Panella said. “As a result, the limited immunity provisions of the MHPA applied to appellants' claim against Dr. Khan.”

In a two-page order granting allocatur March 4, the Supreme Court agreed to take up two issues, as stated by the plaintiffs:

“a. Whether the Superior Court, in reviewing a nonsuit, properly applied the provisions of the Mental Health Procedures Act … and the evidence in the light most favorable to the plaintiffs in granting limited immunity to a drug addiction treatment facility and its physicians where the individual who died while under the care of the facility was not mentally ill and did not seek voluntary inpatient treatment for a mental illness.

b. Whether the Superior Court properly applied fundamental notions of due process and the provisions of the Mental Health Procedures Act … to an individual who did not give consent to voluntary treatment under the MHPA.”

Patrick Mintzer of Buckley Brion McGuire & Morris in West Chester, who represented the plaintiffs, said he and his clients were happy to have the opportunity to argue their case before the Supreme Court.

“We don't believe it was the intended purpose of the act to include drug addiction,” he said, adding, “Our concern is we don't want hospitals or rehab facilities just having patients be seen by psychiatrists in order to invoke the MHPA.”

Daniel Rucket of Rawle & Henderson in Philadelphia, who represented Brandywine, and Sarah Baker of Bonner Kiernan Trebach & Crociata in Philadelphia, who represented Khan and Rana, also could not be reached.

The plaintiffs did partially prevail on their appeal to the Superior Court in July.

The panel found that the trial court erred in granting limited immunity under the MHPA to Duncklee and Plumb, the emergency room doctors.

Although the drug treatment facility provided Johnson care after Duncklee and Plumb saw him, neither emergency room doctor treated Johnson after he'd been seen by a psychiatrist, Panella said.

“At the time Dr. Duncklee saw Johnson, there is no evidence that Brandywine or any other medical facility or professional was currently treating him for mental health issues,” Panella said. “Nor is there any evidence that Dr. Duncklee was even aware of Johnson's psychiatric history.”

Panella, however, acknowledged that the doctors' argument that Johnson was suffering from both physical and mental illness when he visited the emergency room presented a “novel” issue for the court, and he further said the panel was “troubled” that alcoholism and drug dependency are not included in the current definition of mental illness.

“In light of current scientific research, as well as the recent addition of 'addiction disorders' to the American Psychiatric Association's Diagnostic and Statistical Manual V, we suggest that the Department of Human Services revise this definition,” he said in a footnote.

Duncklee and Plumb did not appeal.