The year between 1987 and 1988 was a chaotic one for Mrs. Albright. She was involuntarily committed to Eugenia Hospital and then discharged into an outpatient program. Next, she was involuntarily committed to Thomas Jefferson Hospital, discharged, and soon after involuntarily committed to Montgomery County Emergency Services (MCES). She was discharged from that facility to involuntary outpatient care with a diagnosis of manic depressive disorder. The judge warned her that a failure to participate in therapy once a month, for three months, would result in her return as an inpatient.
Mrs. Albright would not sign a consent to treatment and refused to take her medication. She and her husband did appear for the first and second therapy sessions, however. The psychiatrist advised her to take her medicine and suggested she begin supportive therapy with a social worker in order to gain insight into the need for medication. An appointment was made, but not kept, with a social worker. Mrs. Albright's condition deteriorated to the point where family members worried about her manic behavior.
Mr. Albright contacted the hospital and the MCES. He told the person who answered the telephone that his wife had let the dinner burn in the oven so that smoke was coming out of the oven when he returned from work. She was chain-smoking, walking all night and cigarette burns appeared in new furniture. Her distraught husband was ultimately told that because his wife had missed a previous appointment and the 90-day outpatient treatment period was nearly at end, there was nothing that could be done. An appointment was scheduled for one week later.
The hospital telephoned Mrs. Albright about the rescheduled appointment. She reportedly told the hospital she wanted to focus on Christmas with her family and she was through with appointments. When Mr. Albright returned home, he asked his wife if anyone had called from the hospital. Mrs. Albright replied, "I told them I would meet them at the ocean." That evening, Mrs. Albright was killed in a fire that erupted in the den where she was sleeping.
Mr. Albright brought a negligence claim against the hospital. He argued that the facility was grossly negligent by failing to provide Mrs. Albright with proper treatment, ignoring warnings of her deteriorating mental condition, and failing to commit her as an inpatient.
Under the Mental Health Procedures Act [hereinafter MHPA] the hospital could not be liable unless their actions were grossly negligent. Mr. Albright's claims were dismissed in motion for summary judgment, the trial court and the Superior Court both holding that a reasonable jury could not find that the hospital acted in a grossly negligent manner.
On appeal, Mr. Albright argued that both the MHPA and case law failed to provide a clear definition of the difference between ordinary negligence and gross negligence, and therefore the jury should have been allowed to evaluate the hospital's conduct.
Holding: The Court held that the lower court was correct in deciding the issue of gross negligence in favor of the hospital because the case was entirely free from doubt. Gross negligence had been clearly defined to include "a form of negligence where the facts support substantially more than ordinary carelessness, inadvertence, laxity or indifference" (citing Bloom v. Dubois Regional Medical Center, 409 Pa.Super 83, 597 A.2d 671 (1991)). While Mrs. Albright's failure to attend her December appointment was not promptly addressed, the hospital did attempt to reschedule within one week upon finding out from Mr. Albright that his wife had missed her appointment. The Court also pointed out that the hospital was not informed of Mrs. Albright's dangerous tendencies. At worse, the staff exercised poor judgment in the context of rendering treatment in an "unscientific and inexact field."
Editor's Note: Mark Semisch of Willow Grove, Pennsylvania, attorney for Mr. Albright, does not believe the court's opinion helped clarify the law. He described the Mental Health Procedures Act as a "pro-health care provider law" that could still accomplish good things for patients. But where, he wondered, do we draw the line?
The staff merely exercised poor judgement.
 | James Butcher, Ph.D. Professor of Psychology University of Minnesota |
Dr. Butcher comments: There is something very wrong about the tragic death of Ms. Albright. In all likelihood, from the descriptions of her symptom pattern, she was psychotic and in need of mental health treatment in a safe, secure environment. Her lack of cooperation with outpatient therapy provided clear indication that her treatment regimen on an outpatient basis was ineffective. Yet, the hospital was considered to have followed current practices in treating this patient.
Was this a failure of the community to provide a proper mental health care framework for dealing with severe mental health disorders in a workable context? The changing treatment philosophy and the desire to eliminate mental institutions were initiated by the belief that society wanted and could financially afford to provide better community-based care for chronic patients outside of large mental hospitals.
The deinstitutionalization movement to limit the amount of time disturbed people spend in mental hospitals seemed reasonable to many. However, according to this schema, community-based mental health centers would be opened to provide continuing care to the residents of hospitals after discharge. Residents would be provided medication to keep them stabilized until they could obtain continuing care. (See Torrey, FE , Out of the Shadows: Confronting America's Mental Illness Crisis 1997.)
Many unforeseen problems have plagued deinstitutionalization. Residents of mental institutions have been ill-prepared to deal with their problems outside of the hospital and have been discharged to fates that were even more dehumanizing than the conditions in any of the hospitals. Tragic cases like Ms. Albright's have become commonplace. It is a tragic example of the worst side of mental health treatment in today's health care scene deinstitutionalization.
To many, the process represents the dumping and "losing" of patients in need of continued care into the limbo of the community and family who do not know how to manage living with a severely disturbed relative. Ms. Albright was not properly treated for her bipolar disorder illness and she refused what treatment was offered. As successful as this case was legally for the hospital, it represents an unfortunate failure of the mental health system.
