The opinion
J-S26032-25
2025 PA Super 231
IN THE INTEREST OF: D.L.D. : IN THE SUPERIOR COURT OF
: PENNSYLVANIA
:
APPEAL OF: D.L.D. :
:
:
:
:
: No. 19 MDA 2025
Appeal from the Order Entered December 12, 2024
In the Court of Common Pleas of Centre County Civil Division at No(s):
2018-2865
BEFORE: LAZARUS, P.J., OLSON, J., and BECK, J.
DISSENTING OPINION BY OLSON, J.: FILED: OCTOBER 10, 2025
George Santayana, a Spanish-American philosopher, wrote in 1905,
“Those who cannot remember the past are condemned to repeat it.” In other
words, failure to gain insight from past events can lead one down a path of
repetition, perpetuating the same consequences. By reversing the trial court’s
order extending D.L.D.’s involuntary outpatient mental health treatment, I
believe that the learned Majority is ignoring the extensive history of events
involving D.L.D. thereby condemning the past to be repeated. I must,
therefore, respectfully dissent.
D.L.D. suffers from schizophrenia and he was first committed for
involuntary psychiatric treatment in July 2018. As noted by the Majority,
“[s]ince his initial commitment, D.L.D. has been repeatedly committed to
undergo involuntary inpatient or outpatient psychiatric treatment for long
periods of time. D.L.D. has a lengthy history of noncompliance with his
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prescribed medications, which has exacerbated his psychosis”. Majority
Opinion at 2. Specifically, as described in detail by the Majority, when D.L.D.
is not properly medicated, he experiences paranoid thinking and engages in
threatening and aggressive behavior toward himself and others. Id. at 2-4.
On December 3, 2024, the County filed a petition under the Mental
Health Procedures Act (“MHPA”) seeking an order directing D.L.D. to undergo
an additional 180 days of involuntary outpatient mental health treatment.
Following a hearing before Sonja Napier, Esquire, a Mental Health Review
Officer, Review Officer Napier found sufficient evidence for D.L.D.’s
involuntary outpatient treatment to be extended for another 180 days. On
December 12, the trial court entered an order extending D.L.D.’s outpatient
treatment for a period not to exceed 180 days. D.L.D. filed a petition to review
the certification for treatment with the trial court which was denied.
My learned colleagues set forth in detail the provisions of the MHPA
which are relevant herein and I will not repeat them. See Majority Opinion at
8-11. I merely reiterate that the issue before this Court is whether the County
presented sufficient evidence to establish the need for D.L.D.’s continued
commitment under the MHPA. As the Majority noted, “This requires a finding
that (1) the conduct originally alleged under section 7301(b) actually
occurred, and (2) D.L.D.’s condition continues to evidence a clear and present
danger to himself or others.” Id. at 16 (citations omitted). Additionally, as
noted by my colleagues, D.L.D. does not challenge the sufficiency of the
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evidence as to the first prong; thus we examine the record to determine
whether the evidence is sufficient to establish that D.L.D. is a clear and
present danger to himself which “requires proof by clear and convincing
evidence of two elements: (1) that D.L.D. will be unable to provide for his own
nourishment, housing, personal or medical care, or safety and self-protection
without continued care, supervision, and continued assistance, and (2) there
is a reasonable probability that D.L.D. will die, sustain serious bodily injury or
serious physical debilitation within [30] days if involuntary outpatient
treatment was discontinued”. Id. at 16-17 (citations omitted). Moreover, I
agree with the Majority that the County presented sufficient evidence to
satisfy the first element; hence, we must focus on whether the record is
sufficient to prove by clear and convincing evidence that there is a reasonable
probability that death, serious bodily injury or serious physical debilitation will
ensue within 30 days unless D.L.D. is provided adequate treatment. In
carefully reviewing the record, I conclude that the evidence is sufficient to
establish the second element. Thus, I believe that the trial court was correct
in ordering D.L.D. to undergo involuntary outpatient treatment for a period
not to exceed 180 days.
In reviewing the sufficiency of evidence to support an involuntary
commitment under the MHPA, we review “the facts of record in the light
most favorable to the original decision-maker to determine whether the
requisite standard of proof has been met. In this case, the original
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decision-maker was the review officer”. Interest of J.W.S., 284 A.3d
889 (Pa. Super. 2022) (non-precedential opinion) (citations and corrections
omitted) (emphasis added).1 In setting forth this standard, the J.W.S. Court
cited to our Supreme Court’s decision in In re Vencil, 152 A.3d 235 (Pa.
2017). Although Vencil dealt with the expunction of an individual’s
commitment records, the Supreme Court analyzed the phrase “sufficiency of
the evidence” as applied in a case brought under the MHPA. The Court held,
the phrase “sufficiency of the evidence” is a term of art that has a
precise meaning. … In other legal contexts, both state and federal,
a challenge to the sufficiency of the evidence presents a pure
question of law, requiring review of the facts of record in the
light most favorable to the original decision-maker or
prevailing party (if applicable) to determine whether the
requisite standard of proof has been met.
Id. at 242-243 (emphasis added). The Vencil Court continued:
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.
Id. at 243. In this case, the original decision-maker was Review Officer
Napier. Hence, we must view the facts of record in a light most favorable to
Review Officer Napier who initially determined that the petition for an
extension of D.L.D.’s involuntary outpatient treatment be granted.
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1 See Pa.R.A.P. 126(b) (unpublished non-precedential decisions of the
Superior Court filed after May 1, 2019 may be cited for their persuasive value).
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At the mental health review hearing held on December 9, 2024, Dr.
Jason Rock, the psychiatrist who had been treating D.L.D. “for a few years”
testified that D.L.D. has “poor insight into his mental illness [i.e.,
schizophrenia]. … It seems as if the cycle that he goes through historically is
that he will decompensate, be hospitalized, be placed on medication, come
out and then stop the medications and repeat.” N.T., 6/9/24, at 8, 9-10. Dr.
Rock went on to state “my fear is that without the medication, the following
up with psychiatrists and therapists and case management, that within 30
days or less that he will quickly stop taking his medication,
decompensate and become a danger to himself and others and require
hospitalization or jail time or both.” Id. at 10 (emphasis added). He went
on to conclude within a reasonable degree of medical certainty that there
would be a reasonable probability of death, disability or serious physical
debilitation if D.L.D. were not receiving the recommended treatment. Id. at
11, 16.
Dr. Rock acknowledged that, at the time of the hearing, D.L.D. was
currently compliant with his treatment and, therefore, not a danger to himself
or others. Id. at 11. However, his concern about D.L.D.’s safety was based
upon “his history”. Dr. Rock explained:
But throughout, whether [D.L.D.’s] pleasant or not, he
articulates ambivalence or just outright disagreement with the
fact that he has a mental health diagnosis, that he needs to take
medications, and he views psychiatric care as a burden. And so I
believe that if this weren’t forced upon him from a court
ordered perspective treatment, that he would immediately
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stop the medication and decompensate as he’s done
before.
Id. at 12 (emphasis added).
On cross-examination, Dr. Rock testified that D.L.D. receives his
medication via injection every 28 days and that his last injection was
approximately one week before the hearing. Id. at 17. Counsel for D.L.D.
then asked “[h]ow quick[ly] does [D.L.D.] decompensate if he missed his next
injection?” to which Dr. Rock responded, “I’d hate to find out, but I’m prepared
to say that if he did get [the injection] last week, …, 30 days from now would
put him very much so at risk of decompensating and having that level of
deterioration.” Counsel then asked “[f]om your past experience, how quick is
the decompensation?” Dr. Rock answered “[i]t’s within a matter of weeks.”
Id. at 18.
During his own testimony, D.L.D. was asked by his counsel, “They’re
afraid if you’re not committed, you’ll stop taking the medication. What’s your
position on that?” In response, D.L.D. stated, “[a]s far as I’m concerned, it
should be up to me.” Id. at 26. In my view, D.L.D.’s statement that it
should be up to him to decide whether to take medication and see doctors
lends support to Dr. Rock’s opinion that D.L.D. “articulates ambivalence or
just outright disagreement” with the fact that he has a serious mental
diagnosis and must take medications and that, if left to his own devices,
D.L.D. would not obtain the necessary treatment, decompensate, and
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deteriorate within 30 days resulting in a reasonable probability that he would
die, sustain serious bodily injury or serious physical debilitation.
My learned colleagues acknowledge that there is “ample support” in the
record that “D.L.D.’s behaviors during his most recent commitment reflect a
high likelihood that he will discontinue his medications and become psychotic”.
Majority Opinion at 20. However, they believe that the evidence fails to
establish a “substantial likelihood” or a “stronger chance than a possibility”
that this would result in the statutorily required harm to D.L.D. Hence, they
conclude that Dr. Rock’s testimony was “at best, speculative that harm ‘could
conceivably’ occur.” Id.
I agree that we cannot determine with absolute certainty that D.L.D.
will be at risk of death, serious bodily injury or serious physical debilitation if
involuntary outpatient treatment is not ordered. I also agree that, if Dr. Rock
had only recently begun caring for D.L.D. and was not familiar with his mental
health history, Dr. Rock’s conclusions would be “at best, speculative”.
However, the evidence clearly and convincingly establishes that Dr. Rock has
a lengthy history with D.L.D. and is acutely aware of the fact that D.L.D. does
not acknowledge his serious mental illness, and, unless involuntary outpatient
treatment is ordered, he will refuse to take the medication and pursue the
treatments that he absolutely needs to address his illness. The evidence also
establishes that, when he is in a psychotic state, D.L.D. risks death, serious
bodily injury or serious physical debilitation. As noted by the Majority, when
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not treated, D.L.D.’s illness resulted in him believing his food was
contaminated and, therefore, he would not eat; he exhibited threatening and
aggressive behaviors toward businesses and individuals, including judges,
government officials, and police officers; and he ran into oncoming traffic in
the middle of the street. In my view, these actions which occurred when not
receiving treatment, are actions that put D.L.D. at risk of death, serious bodily
injury or serious physical debilitation. As the old adage goes, “The best
predictor of future behavior is past behavior”. D.L.D.’s past behavior predicts
that, without involuntary outpatient treatment, there is a substantial likelihood
that he will devolve into a psychotic state within weeks resulting in serious
harm.
Based upon our standard of review and the evidence of record, I would
affirm the trial court’s order directing D.L.D. be committed to involuntary
outpatient treatment for a period not to exceed 180 days.
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