J-A34045-15
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
IN THE INTEREST OF: D.C.W. IN THE SUPERIOR COURT OF
PENNSYLVANIA
APPEAL OF: D.C.W.
No. 1218 MDA 2015
Appeal from the Order Entered June 12, 2015
In the Court of Common Pleas of Centre County
Civil Division at No(s): 2015-1994
BEFORE: PANELLA, J., OTT, J., and JENKINS, J.
MEMORANDUM BY JENKINS, J.: FILED JANUARY 06, 2016
Appellant D.C.W. appeals from the order entered in the Centre County
Court of Common Pleas, which denied his petition for review of certification
to involuntary inpatient mental health treatment. We affirm.
The relevant facts and procedural history of this appeal are as follows.
On June 2, 2015, the Office of Mental Health and Intellectual Disabilities of
Centre County filed a petition seeking extended involuntary treatment of
Appellant pursuant to Section 7304 of the Mental Health Procedures Act
(“MHPA”).1 The next day, a mental health review officer conducted a
hearing in which Dr. Carol Eidsvoog, staff psychiatrist at Rockview Mental
Health Unit, testified that Appellant suffers from anorexia nervosa, the
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1
50 P.S. § 7304.
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binging and purging type.2 N.T., 6/3/15, at 7. Dr. Eidsvoog testified that
Appellant had purged to the point of severe electrolyte abnormalities and
dehydration and contraction alkalosis, and that without care and assistance,
Appellant’s behavior could lead to death, disability or serious physical
debilitation within thirty (30) days. Id. at 7-8.
Appellant testified that he had been doing very well eating and keeping
his food down, and that he felt healthy. Id. at 14. He further testified that
he still had certain struggles at certain times of the day, but that he wanted
to go home as soon as possible. Id. at 14-15.
After the hearing, the mental health review officer granted the petition
to extend Appellant’s involuntary treatment for ninety (90) days. On June
10, 2015, Appellant filed a petition for review of certification to involuntary
inpatient mental health treatment in the Centre County Court of Common
Pleas. On June 12, 2015, the court denied Appellant’s petition. On July 7,
2015, Appellant timely filed a notice of appeal. On July 13, 2015, the trial
court ordered Appellant to file a concise statement of errors complained of
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2
Anorexia nervosa is defined as “an eating disorder usually occurring in
adolescent females, characterized by refusal to maintain a normal minimal
body weight, fear of gaining weight or becoming obese, disturbance of body
image, undue reliance on body weight or shape for self-evaluation, and
amenorrhea. The two subtypes include one characterized by dieting and
exercise alone and one also characterized by binge eating and purging.”
DORLAND’S MEDICAL DICTIONARY FOR HEALTH CONSUMERS (2007), available at,
http://medical-dictionary.thefreedictionary.com/anorexia.
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on appeal pursuant to Pa.R.A.P. 1925(b), and he timely complied on July 17,
2015.
Appellant raises the following issue for our review:
WHETHER THE TRIAL COURT LACKED CLEAR AND
CONVINCING EVIDENCE FROM WHICH IT COULD
CONCLUDE FORCED PSYCHIATRIC TREATMENT UNDER
THE MENTAL HEALTH PROCEDURES ACT WAS NECESSARY
WHERE IT WAS UNDISPUTED THAT UNFORCED MEDICAL
ATTENTION WAS READILY AVAILABLE AT THE PRISON TO
ACHIEVE THE TREATMENT OBJECTIVES SOUGHT BY THE
PRISON?
Appellant’s Brief at 4.3
Appellant argues that the state failed to establish, by clear and
convincing evidence, that Appellant was in need of involuntary treatment
when he was voluntarily working on techniques designed to abate his self-
injurious behaviors. We disagree.
“In reviewing a trial court order for involuntary commitment, we must
determine whether there is evidence in the record to justify the court’s
findings.” In re T.T., 875 A.2d 1123, 1126 (Pa.Super.2005) (quoting
Commonwealth ex rel. Gibson v. DiGiacinto, 439 A.2d 105, 107
(Pa.1981)). “Although we must accept the trial court’s findings of fact that
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3
Although Appellant’s 90 day period of involuntary commitment has ended,
Appellant’s issue is not moot because it is capable of repetition and may
evade review. See In re Woodside, 699 A.2d 1293, 1296
(Pa.Super.1997).
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have support in the record, we are not bound by its legal conclusions from
those facts.” Id.
The MHPA provides:
§ 7304. Court-ordered involuntary treatment not to
exceed ninety days
(a) Persons for Whom Application May be Made.--(1)
A person who is severely mentally disabled and in need of
treatment, as defined in section 301(a), may be made
subject to court-ordered involuntary treatment upon a
determination of clear and present danger under section
301(b)(1) (serious bodily harm to others), or section
301(b)(2)(i) (inability to care for himself, creating a
danger of death or serious harm to himself), or
301(b)(2)(ii) (attempted suicide), or 301(b)(2)(iii) (self-
mutilation).
(2) Where a petition is filed for a person already subject to
involuntary treatment, it shall be sufficient to represent,
and upon hearing to reestablish, that the conduct originally
required by section 301 in fact occurred, and that his
condition continues to evidence a clear and present danger
to himself or others. In such event, it shall not be
necessary to show the reoccurrence of dangerous conduct,
either harmful or debilitating, within the past 30 days.
50 P.S. § 7304.
§ 7305. Additional periods of court-ordered
involuntary treatment
(a) 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
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period of involuntary treatment shall not exceed 180 days;
provided that persons meeting the criteria of section
304(g)(2) may be subject to an additional period of up to
one year of involuntary treatment. 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 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.
50 P.S. § 7305 (internal footnote omitted).
In order for a person to be committed to an extended period of
treatment:
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, Section 7305(a); i.e. his condition continues to
evidence a clear and present danger to himself or others,
Section 7304(a).
Commonwealth v. Romett, 538 A.2d 1339, 1341 42 (Pa.Super.1988).
“It is well-settled that involuntary civil commitment of mentally ill
persons constitutes deprivation of liberty and may be accomplished only in
accordance with due process protections.” In re R.D., 739 A.2d 548, 554
(Pa.Super.1999) (quoting In re Hutchinson, 454 A.2d 1008, 1010
(Pa.1982)). “The appropriate standard of proof for certification of extended
involuntary treatment is clear and convincing evidence”. In re Hancock,
719 A.2d 1053, 1056-57 (Pa.Super.1998). “Requiring clear and convincing
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evidence that an individual represents a clear and present danger to himself
or others places the burden squarely on the facility or individual attempting
to commit the individual involuntarily.” Id.
The trial court considered the clear and convincing evidence standard
and reasoned:
In this case, these standards were satisfied by testimony
of Dr. Carol Eidsvoog, M.D. a staff psychiatrist at Rockview
Mental Health Unit who was [Appellant’s] treating
physician. She testified that [Appellant] suffers from
anorexia nervosa, binging and purging type. He posed a
danger to himself by binging and purging because he had
binged and purged to the point of suffering severe
electrolyte abnormalities, dehydration, contraction
alkalosis, and medical problems. The contraction alkalosis
improved but was still abnormal. He had not reached the
target weight the medical doctors sought. He was unable
to provide for his own basic needs. [Appellant] was doing
better and was developing self-distraction techniques after
eating to avoid purging but could not do so by himself and
needed help by staff to avoid purging. Without care and
assistance there was a reasonable probability of death,
disability or serious physical debilitation within 30 days
especially with his physical exam abnormalities and lab
abnormalities at admission. He has suffered some
permanent physical deficits from his history of anorexia
nervosa. He was prescribed Remeron for sleep difficulties,
vitamin D, and iron supplements. Dr. Eidsvoog sought a
Section 304 commitment to keep working therapeutically
to help him to avoid purging after meals and to be less
restrictive in his food intake. She also planned that he
would receive cognitive therapy to deal with stress and
control issues. She stated inpatient treatment was the less
restrictive environment for him to receive the necessary
treatment.
When [Appellant] was ordered to undergo mental health
treatment under Section 303, he weighed 97 pounds at
5’11”. It was clear to this [c]ourt that [Appellant] was still
in need of involuntary mental health treatment for his
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anorexia nervosa and without the treatment he had a
reasonable probability of death, disability or serious
physical debilitation within 30 days. He was unable to
provide for his basic need of food/nutrition which was
demonstrated by the fact that his labs remained abnormal,
he still had contraction alkalosis, he still needed the
assistance from staff to avoid purging, and he had not
reached his target weight. This [c]ourt does not agree with
[Appellant] that the evidence established that unforced
medical attention was readily available to achieve the
treatment objectives as the therapies recommended were
not available outside of the mental health unit.
Trial Court Pa.R.A.P. 1925(a) Opinion, filed August 17, 2015, at 2-3.
Based on our review of the record, we conclude the trial court properly
certified Appellant’s continued involuntary treatment under Section 7304
based on sufficient evidence of a clear and present danger he presented to
himself. See 50 P.S.§ 7304(a)(2). Accordingly, we affirm.
Order affirmed.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 1/6/2016
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In the Int. of: D.C.W.
Combined Opinion