Martin Case Looks at the Application of the Pennsylvania Mental Health Procedures Act and the Gross Negligence Standard for Patients Arriving in the ER


In Martin v. Holy Spirit Hospital, the Pennsylvania Superior Court reversed the trial court's decision granting the defendant hospital's preliminary objections in a case where a woman who said she was suicidal left an emergency room while awaiting an evaluation and walked into traffic on a nearby highway. The Superior Court held that the limited immunity provision of the Pennsylvania Mental Health Procedure's Act (MHPA) applied considering the "treatment" provided at the hospital, but found the complaint allegations were sufficient to plead facts that met the MHPA's gross negligence standard.

The patient had a history of mental health problems and was taken by ambulance to the defendant hospital after attempting suicide. She agreed to a voluntary admission and was placed in an exam room at the defendant hospital. While she awaited an evaluation by a physician or "crisis intervention team" in the ER, she expressed suicidal intent several times. She changed into a hospital gown and slippers, but had not been admitted to the facility nor had she been examined by a physician or psychiatrist. One hour and 15 minutes after arriving at the ER, the patient left the exam room, walked past the charge nurse's station, the billing desk, went through a first set of unlocked exit doors, entered the lobby and exited through unlocked doors. She walked onto the highway, where she was struck by a motor vehicle and killed. The plaintiffs noted the defendant hospital was investigated by the Pennsylvania Department of Health as a result of the incident, which found the patient was the ninth mental health crisis patient to leave the ER "without any crisis intervention evaluation" within a three and a half month period.

The Superior Court found that the MHPA's immunity provision applied to the hospital, but that the plaintiffs had pled facts to meet the gross negligence threshold to overcome the MHPA's immunity provision. Thus, the Court held the trial court erred by granting the defendant hospital's preliminary objections.

  1. Definition of "Treatment": The Court found the hospital was a facility providing "treatment" under the MHPA and therefore the MHPA's limited immunity provision applied. The patient had not been admitted to the hospital or evaluated by a physician, crisis personnel or mental health professional while in the ER before leaving. The Court noted the patient was seen by trained nursing staff and "some degree of medical care was administered." The facts cited by the Court included: (1) the nurse recorded the patient's history of suicide attempt an hour earlier; (2) the medical record documented her complaint as "CRISIS; SUICIDAL"; (3) ER staff recorded the patient's psychiatric history of depression, anxiety and suicide attempts, active suicidal thoughts when questioned; and (4) records at the facility noted "patient still actively suicidal stating she wishes they would let her jump."
  2. Gross Negligence: The Martin Court found the plaintiffs had sufficiently pled allegations to constitute gross negligence, thus overcoming the MHPA's limited immunity provision at the pleadings stage. The Court noted the plaintiffs alleged the hospital's own protocols required the patient to receive close monitoring with one-on-one observation and the patient was waiting for one and a half hours in the ER without being evaluated by a physician, psychiatrist, or crisis intervention staff. The Court noted the patient was the ninth mental-crisis patient in the past three and a half months to leave from the ER and the hospital had failed to respond with preventative measures.

Comment: The Martin case is important because it provides guidance on two prongs of the MHPA's limited immunity provision inquiry: (1) whether the MHPA's limited immunity provision applies; and (2) what constitutes gross negligence at the pleadings stage to overcome the limited immunity provision. With respect to the first prong, Martin distinguished Fogg v. Paoli Mem'l Hospital, 686 A.2d 1355 (Pa. Super. Ct. 1996), a case wherein the patient did not interact with anyone at the hospital other than the registrar upon arriving in the ER with his parents. He was told to sit in the waiting room and was not seen by any medical professionals despite his parents advising the registrar their son was experiencing hallucinations and had a bed reserved for his admission by his treating psychiatrist. After multiple requests, the patient and his parents were sent down a hallway unescorted. The patient became agitated and ran down the hallway, crashing through the window and falling two stories onto the concrete driveway. The Court found the hospital was not entitled to limited immunity under the MHPA, reasoning the patient had not been seen by any healthcare professionals while in the ER. In Fogg, the patient checked in with the ER registrar and was awaiting initial contact with healthcare staff.

With respect to gross negligence, the Martin Court emphasized the patient was able to leave the ER while wearing only the hospital gown and socks given to her in the ER, walking through two sets of unlocked doors, in plain view of various hospital staff, despite the fact that eight other patients had left from the hospital's ER before a crisis evaluation during the past three and a half months.

For more information, please contact Joseph Goldberg at or 215.825.7225.

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