Allowing a medical practice to be sued for the mass shooting perpetrated by a client who'd been considered a candidate for involuntary commitment would create an "absurd, even dangerous" precedent for health care providers in Pennsylvania, an attorney argued to the state Supreme Court.

The justices on Tuesday heard oral arguments in a case, captioned Leight v. University of Pittsburgh Physicians, to address whether doctors can be held liable under the Mental Health Procedures Act if they begin but fail to complete the process of involuntary commitment when they recognize their patient is "severely mentally ill and a clear and present danger to others."

The case stems from the March 2012 mass shooting at the Western Psychiatric Institute and Clinic, where John Shick killed one person and injured several others, including plaintiff Kathryn Leight.

At the beginning of the argument session, which was livestreamed on YouTube, the plaintiff's counsel told the justices the fact that the doctors took affirmative steps toward involuntarily commitment established their liability under the act, but Dickie, McCamey & Chilcote attorney John Conti, who is representing the doctors, told the court that allowing the case to proceed would unfairly penalize doctors for seeking treatment they deemed appropriate and would create unnecessary ambiguity about when a person is said to have been involuntarily committed under the act.

"There needs to be a bright-line demarcation for when the process for involuntary commitment begins, and that is so because the procedure involves a profound deprivation of an individual's liberty. The act does provide for those precise exacting, clear and unambiguous steps … not as superfluous paperwork as the plaintiff alleges, but rather as the foundation as the patient's constitutional right to due process," Conti said. "I respectfully urge that the court exercise restraint and consider the profound unfairness in imposing such expansive third-party liability on medial professionals for the criminal acts of others."

Leight's counsel, Mark Homyak, however, contended that the defendant doctors took several steps toward involuntarily committing Shick, including reaching out to a psychiatric facilities and discussing ways for the doctors to obtain the necessary paperwork.

"I don't know what you'd call that, other than evidence that they reached a decision," he said.

Several justices, however, said the case appeared to operate in a legally muddled area, with Justice David Wecht saying the facts "enmesh the courts in a pretty substantial gray area."

Justice Max Baer asked Homyak whether his arguments about the applicability of the MHPA meant that doctors who note concerns about their patient's mental health run the risk of subjecting themselves to liability, to which Homyak responded that no, there were at least 30 references in the record regarding the need for Shick to be involuntarily committed.

"I can get a case to the jury because this is involuntary treatment, and therefore within the scope of the act, and it's specifically prohibited that a physician cannot grossly, negligently deal with an involuntary examination decision," Homyak said.

"So, the doctor has to take some steps towards involuntary commitment and not follow through?" Baer asked.

"Correct," Homyak said.

Justice Debra Todd had similar questions about where the high court would draw the line.

"It's a very gray area for us to apply to the whole commonwealth," Todd said. "As long as we're in that gray area up to an execution of an involuntary commitment, I don't know how we can draw that line as a statewide policy."

Homyak said the fact that the doctors called a psychiatric hospital requesting Shick be committed should be considered initiating the process.

Conti, however, countered that physicians don't have a duty to involuntarily commit patients, and that the line for when the conduct falls under the act is when the patient's liberty is infringed on.

"Involuntary commitment requires emergency examination at an approved facility, those are iron-clad, bright-line requirements … these are constitutional, due process protections," Conti said. "If they are not present, the procedure has not begun under the statute."

Toward the end of the argument Justice Christine Donohue honed her questions in on another part of the statute, asking Conti why the General Assembly would have provided for certain immunities in the statute if it didn't intend for the physicians to be subject to liability.

"As I read it, it anticipates conduct for which there may be liability that precedes the actual involuntary commitment," Donohue said.

Conti argued that the legislature was still not immunizing the conduct that did not fall under the act.

"It in no way contemplates that a decision, as that term is used, would imply conduct of a physician at home or anywhere in the office engaging in a conversation or a contemplation off something," Conti said. "That would be a very unsound way to view that. It must be viewed in toto."