Physician-Patient Relationship

Proper mental health care requires qualified immunity protections

Tanya Albert Henry , Contributing News Writer

Mental health care in Pennsylvania is in the hands of the commonwealth’s highest court.

A patient’s wife, Kathryn J. Wunderly, is asking the Pennsylvania Supreme Court to let her pursue a lawsuit that seeks to hold a hospital accountable for care she says they “failed” to provide her husband.

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Wunderly argues that Pennsylvania’s Mental Health Procedures Act (MHPA) doesn’t give the hospital immunity from the claim. She believes the law distinguishes between actual treatment and the failure to treat. Wunderly argues that, because the hospital failed to treat her husband, the MHPA doesn’t provide the hospital qualified immunity.

Physicians tell the court there is no distinction between the two and that creating one could impede patient access to mental health care or lead to patients receiving necessary care.

The woman’s “argument, if accepted, could induce healthcare providers for fear of being accused of failing to treat or provide unnecessary treatment,” says a brief filed by the Litigation Center of the American Medical Association and State Medical Societies and the Pennsylvania Medical Society in the case, Wunderly v. St. Luke’s Hospital. “Even worse, faced with the threat of increased liability, mental health providers might refuse to provide treatment for patients with mental illness, if they are able to do so.”

The physicians’ brief urges the Pennsylvania Supreme Court to uphold lower court decisions that dismissed Wunderly’s claim after ruling the Mental Health Procedures Act protected the hospital from the claims.

Find out more about the cases in which the AMA Litigation Center is providing assistance and learn about the Litigation Center’s case-selection criteria.

Wunderly’s late husband—Kenneth Wunderly—was involuntarily committed to St. Luke’s. He was a hospital inpatient for a little more than two weeks and then transferred to elsewhere for long-term care where he passed away. He had dementia, suffered from auditory and visual hallucinations and was physically abusive toward the staff who treated him, court records show.

She claims the hospital didn’t have proper protocols for wound care and prevention, leading to his pressure ulcers that caused his decline and death. Wunderly also says treatment for her husband’s ulcers “in no way arose out of” his mental illness.

The AMA Litigation Center and the Pennsylvania Medical Society told the court that none of that takes away from MHPA’s immunity, saying that the law “does not require a causal connection between a patient’s mental illness and the treatment rendered by healthcare providers. And even so, all treatment rendered by Saint Luke’s did arise from her husband’s mental illness.”

The MHPA provided comprehensive reform to Pennsylvania laws that governed mental-health treatment in the mid-1970s.

It favors voluntary treatment over involuntary treatment, which was not the case prior to the MHPA, and it limits the length of involuntary treatments. It also gives qualified immunity to caregivers and others who treat a patient population that requires special skills and comes with special risks as patients can become violent or may be unwilling, unable or unreliable historians of their own physical- and mental- health history.

“By providing qualified immunity, the General Assembly appropriately balanced the safety of patients and others against the need to ensure liability protections for healthcare providers so that mental-health treatment is available,” the physician organizations’ brief says.

Qualified immunity doesn’t translate to patients receiving substandard care and immunity also doesn’t apply to cases where gross negligence or willful misconduct took place, the brief goes on to say.

Without qualified immunity, a physician may prescribe something to a patient defensively so they aren’t sued for ordinary negligence for failing to provide that mediation. A plaintiff may dodge immunity by saying the doctor “failed” to prescribe a certain regiment or treatment, even though they were provided with a different treatment. Or administrators may refuse to discharge a patient to avoid liability that they “failed” to keep them in the facility.

The brief tells the court that “slicing and dicing as Wunderly requests, would detrimentally affect mental-health care in Pennsylvania.”

The most recent edition of “Medical Liability Reform NOW!” (PDF) gives physicians the facts they need to address the broken medical liability system, including updates on state laws, innovative reforms, efforts to reform the system at the federal level, and high-impact court cases at the federal and state levels.