In Re: A.P., Appeal of: A.P. ( 2021 )

J-S32032-21
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
IN RE: A.P. : IN THE SUPERIOR COURT OF
: PENNSYLVANIA
:
APPEAL OF: A.P. :
:
:
:
:
: No. 480 WDA 2021
Appeal from the Order Entered March 23, 2021
In the Court of Common Pleas of Erie County Civil Division at No(s):
70129 of 2013
BEFORE: LAZARUS, J., MURRAY, J., and MUSMANNO, J.
MEMORANDUM BY MUSMANNO, J.: FILED: December 3, 2021
A.P. appeals from the Order of the trial court, which affirmed the
certification of continued involuntary mental health treatment pursuant to
sections 301 and 305 of the Mental Health Procedures Act (“MHPA”). See 50
P.S. §§ 7301 and 7305. We affirm.
Relevant to the instant appeal, A.P. has a lengthy history of psychiatric
illness. On December 14, 2019, A.P. was arrested for defiant trespass. N.T.,
3/17/21, at 4. Id. On January 17, 2020, A.P. entered a guilty plea to defiant
trespass, at which time he was sentenced to 30 days of confinement with
probation. Id. On January 20, 2020, A.P. was arrested for violating a
Protection From Abuse Act1 Order (“PFA”). Id. at 5. While in jail, A.P. was
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1 See 23 Pa.C.S.A. §§ 6101-6122.
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non-compliant with his medications, and urinated and defecated in his cell.
Id. A.P. also “had been naked and masturbating at the cell gate, and engaged
in verbal distraction, including banging on doors, [and] ranting and raving in
his cell.” Id. A.P. was found to be not competent to stand trial, and
transferred to Torrance State Hospital (“Torrance”). Id. at 6. At Torrance,
A.P. continued to have delusions regarding the alleged victim in his case. Id.
On September 25, 2020, the trial court entered an Order directing A.P.’s
transfer to Warren State Hospital (“the Hospital”). Trial Court Order, 9/25/20.
In a Petition dated February 4, 2021, the Hospital requested an additional
period of continuing involuntary mental health treatment of A.P., pursuant to
sections 301 and 305 of the MHPA. Petition, 2/4/21. On February 24, 2021,
A.P. appeared before the Mental Health Review Officer (“MRO”), for a hearing
on the Hospital’s Petition. At the conclusion of the hearing, the MRO certified
A.P. for continuing involuntary mental health treatment for a period not to
exceed 180 days. MRO Order, 2/24/21. A.P., through counsel, filed a Petition
for Review of the certification by the trial court. On March 17, 2021, the trial
court conducted a hearing on A.P.’s Petition for Review. On March 22, 2021,
the trial court entered an Order, which affirmed the MRO’s Order certifying
A.P.’s continuing involuntary mental health treatment, pursuant to sections
301 and 305. A.P. timely filed a Notice of Appeal, followed by a court-ordered
Pa.R.A.P. 1925(b) Concise Statement of matters complained of on appeal.
A.P. presents the following claim for our review:
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DID THE [TRIAL COURT] COMMIT AN ABUSE OF DISCRETION OR
ERROR OF LAW IN FINDING THAT [THE] HOSPITAL PRESENTED
COMPETENT EVIDENCE THAT DEATH OR SERIOUS PHYSICAL
DEBILITATION OR BODILY INJURY TO SELF OR OTHERS WAS
LIKELY IMMINENT IF [A.P.] WAS NOT FORCED TO UNDERGO
CONTINUED INVOLUNTARY PSYCHIATRIC TREATMENT?
Brief for Appellant at 7.
We review involuntary treatment orders under the MHPA to “determine
whether there is evidence in the record to justify the [hearing]
court’s findings.” In re S.M., 176 A.3d 927, 935 (Pa. Super. 2017) (citation
omitted). But see also id. (recognizing that an appellate court is not bound
by a hearing court’s legal conclusions derived from the facts). In reviewing a
challenge to the sufficiency of the evidence supporting a determination under
the MHPA, we have stated the following:
Deference to the facts as found by the original factfinder is of
particular importance in circumstances where the factfinders have
specialized training or knowledge that makes them uniquely
qualified to reach the findings and conclusions the General
Assembly has entrusted them to make.
In re Vencil Appeal of Pa. State Police, 152 A.3d 235, 243 (Pa. 2017);
see also Harris v. No. 1 Contracting Corp., 258 A.2d 663, 664 (Pa. Super.
1969) (stating that a reviewing court may not substitute its judgment as to
the facts found by the factfinder).
A.P. claims that the Hospital failed to demonstrate that his condition
“continues to evidence a clear or present danger to himself or others[,] by
conduct during the most recent period of court-ordered treatment.” Id. at
24. A.P. argues that “[e]ven when left to surmise the basis for the
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commitment, … the record does not establish that an extended [section ]305
commitment was warranted.” Id. A.P. directs our attention to testimony
that, during his time at the Hospital, he has taken his medication, interacted
with staff, and no longer conveyed any delusional thoughts about having a
relationship with the person protected by the PFA. Id. at 25. In addition, A.P.
testified that his current medications work well, and that he agrees to take
them twice per day. Id. A.P. points out his testimony that he can rely on the
tools he has learned, and that he can take the medication himself. Id. A.P.
further expressed his desire to work with his previous psychiatrist at the Erie
County Prison. Id. at 25-26. A.P. further directs our attention to his
testimony regarding his willingness to work with a medication monitor, so that
he would not forget to take his medication. Id. at 26.
We recognize that
[i]nvoluntary civil commitment of the mentally ill unquestionably
constitutes a deprivation of liberty and may be accomplished only
in accordance with due process protections. Accordingly, the
petitioner in an involuntary commitment proceeding must prove
the requisite statutory grounds by clear and convincing evidence.
Commonwealth v. Helms, 506 A.2d 1384, 1388 (Pa. Super. 1986). “In
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).
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The MHPA provides, in relevant part, as follows:
(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) ….
(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. Section 305 provides, in relevant part, as follows:
At the expiration of a period of court-ordered involuntary
treatment under section 304(g) or this section, the court may
order treatment for an additional period upon the application of
the county administrator or the director of the facility in which the
person is receiving treatment. Such order shall be entered upon
hearing on findings as required by sections 304(a) and (b), and
the further finding of a need for continuing involuntary treatment
as shown by conduct during the person’s most recent period of
court-ordered treatment. The additional period of involuntary
treatment shall not exceed 180 days …. A person found dangerous
to himself under section 301(b)(2)(i), (ii) or (iii) shall be subject
to an additional period of involuntary full-time inpatient treatment
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only if he has first been released to a less restrictive alternative.
This limitation shall not apply where, upon application made by
the county administrator or facility director, it is determined by a
judge or mental health review officer that such release would not
be in the person’s best interest.
Id. § 7305(a). As this Court has explained,
for a person to be recommitted for an additional period of
treatment, it need not be established that the person has inflicted
or attempted to inflict serious bodily harm upon another within
the past thirty days, as required for the original commitment. The
[MHPA] specifically states that on recommitment it is not
necessary to show that the patient committed an overt act within
30 days of the hearing. It is necessary however for the court to
find that within the patient’s most recent period of
institutionalization, the patient’s conduct demonstrated the need
for continuing involuntary treatment, … i.e.[,] his condition
continues to evidence a clear and present danger to himself or
others ....
Commonwealth v. Romett, 538 A.2d 1339, 1341-42 (Pa. Super. 1988).
With that in mind, we review the record to determine whether the
evidence supports the trial court’s Order for the continuing involuntary mental
health treatment of A.P., pursuant to 50 P.S. § 7305.
Our review discloses that, on February 24, 2021, the MRO entered an
Order for continuing involuntary treatment of A.P. MRO Order, 2/24/21. The
MRO found that A.P. was “[i]nitially incarcerated for violation of a PFA ….” Id.
at 1. According to the MRO, A.P. had engaged in “some bizarre behavior[,]”
and had a “history of bizarre and disorganized behavior[.]” Id. The MRO
found that A.P. “would be unable to care [for] himself outside of [a]
hospital[.]” Id. Finally, the MRO noted A.P.’s diagnosis of schizoaffective
disorder. Id.
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At the February 24, 2021, hearing before the MRO, A.P. recognized that
he had a period of “instability” regarding his bipolar disorder for about two
years and seven months. N.T., 2/24/21, at 15. A.P. indicated that he had
issues with fear and anxiety due to post-traumatic stress disorder. Id. A.P.
testified that he is a veteran and an evangelist. Id. A.P. further testified as
follows:
I do not belong here. I’m responsible enough to take my
medicines. Things have happened in the past where I was, in a
way, being tortured by a demon. I know that may seem hard to
believe, but that’s what happened. I – it’s over with, that issue.
… I am pursuing my mental health, emotional health. And
medication monitor—I believe, Stairways and/or [the Veterans’
Administration] medical community can provide for medication
monitor just to make sure, you know, I don’t forget to take my
medicine.
… I’m not a threat to myself. I’m not a threat to others. I
can survive safely in the community … I feel great….
Id. at 18.
At the March 17, 2021, hearing before the trial court, Isabelita Cesar,
M.D. (“Dr. Cesar”), testified that A.P. has a diagnosis of schizoaffective
disorder. N.T., 3/17/21, at 6. Dr. Cesar explained that A.P. “has a history of
noncompliance with his medication.” Id. According to Dr. Cesar,
[A.P. has] been taking his medications for his psychiatric
(unintelligible)[,] but his behavior is not consistent with reality.
He’s been saying that [he] was discharged and he’s leaving.
[] [O]verall, we had actually wanted him to benefit from
further inpatient hospitalization, and he [sic] wanted to complete
the self-medication education program. But because of his
consistent noncompliance with medication and subsequent
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decompensation, he becomes delusional when he’s not on
medication.
… And we also have … [a] community support plan for him
… where they have services in place for him before … he goes back
to the community.
… [A.P.] still has active legal charges and will be discharged
to the jail. … [B]ut nevertheless, he wants to go with the
community support plan so that when he’s sat in jail[,] he will be
able to [access] base [unit] services in the community.
Be advised that if he’s out there, and he’s allowed to go back
to the community, he has a … recurring pattern of this delusion
that he[,] for some reason[,] will believe he is married to someone
he is related to, and cause problem [sic] with the legal charges
and the safety of others.
Id. at 7-8.
Dr. Cesar further explained that A.P.’s medication education program
has just begun. Id. at 9. Dr. Cesar testified that, “[h]opefully[,] with that
education, [A.P.] might have better insight regarding the need for continued
treatment, medication compliance.” Id. Dr. Cesar estimated that the
medication education program will take “[a] few weeks.” Id. at 10.
Dr. Cesar further testified that, in the three to four weeks prior to the
hearing, A.P. interacted with staff, but “not much with our patients[.]” Id. at
11. She pointed out some unusual behavior, where A.P. “just goes and sits
out there, possibly … out of the door, saying that he’s discharged[,]” and that
she has “addressed that with him on maybe three or four occasions.” Id.
Finally, when asked whether A.P. could go to a home “and do what he needs
to do to get by[,]” Dr. Cesar responded, “No, not at this time.” Id. at 12-13.
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Dr. Cesar confirmed that her opinion regarding A.P. had not changed
since the February 24, 2021, hearing before the MRO. Id. at 8. At that
hearing, Dr. Cesar testified regarding A.P.’s history of noncompliance with his
medication while in jail:
[T]here is a history that[,] when [A.P.] is in jail, he stopped taking
the medication. And then, according to the records, when he
stopped taking the medication, he became paranoid; he was
urinating and defecating in his cell and started smearing feces and
for [sic] rapid, flight of speech and did some other bizarre
behavior….
N.T., 2/24/21, at 7. Dr. Cesar stated her belief that continued care was
necessary. Id. at 8.
Dr. Cesar further testified that A.P. posed a risk to himself and others
without the continuing involuntary mental health treatment:
I’m projecting that without the treatment on the unit of this
medication program, he might go back to not taking medication
while he’s in jail[,] and by history he can decompensate and
become very psychotic with inability to take care of himself
without that self-medication.
… I would say by his history and … his poor appetite and sleeping
and responding to paranoid stimuli, being naked, masturbating,
talking to himself while in his cell, smearing feces and all those,
so those are very disorganized behavior that one would not be
able to take care of himself.
Id. at 8-9.
We recognize the progress made by A.P. during his treatment.
However, mindful of our standard of review, we conclude that there was
sufficient evidence to support the trial court’s Order for the continuing
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involuntary treatment of A.P. under sections 301 and 305 of the MHPA.
Accordingly, we affirm the Order of the trial court.2
Order affirmed.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 12/3/2021
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2 In his brief, A.P. also argues that the trial court “did not make any specific
factual findings” in support of its March 22, 2021, Order. Brief for Appellant
at 22. However, A.P. raised no issue in this regard in his Pa.R.A.P. 1925(b)
Concise Statement of matters complained of on appeal. Accordingly, it is
waived. See Pa.R.A.P. 302(a) (stating that an issue cannot be raised for the
first time on appeal); see also Commonwealth v. Hansley, 24 A.3d 410,
415 (Pa. Super. 2011) (recognizing that issues not raised in a Rule 1925(b)
statement will be deemed waived for review).
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