2007 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit

3-14-2007 

# D eJ es u s v . U S D ept V et e r ans
P r e c e de nt i al or N on-P r e c e de nt i al : P r e c e de nt i al D ocke t N o . 05-4952

F o llow thi s and a dd it ion al work s at : http://d i git alc ommon s .l a w . vi ll anova . e du/thir dc ir c uit_2007

Thi s de c i sion i s br ou ght t o you for f r e e and ope n a c c e s s b y the O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit at V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. It h as be e n a c c ept e d for inclusion in 2007 D e c i sion s b y an author i z e d a dmini s tr at or of V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. F or mor e inform at ion, p le as e c ont a ct Be n j amin
. C arl s on@l a

w . vi ll anova . e du

. Re c omme nde d C it at ion

" D eJ e s us v . U S D ept V

e t e r an s " (2007). 2007 D e cisio n s . P ape r 1387. http://d i git alc ommon s .l a

w . vi ll anova . e du/thir dc ir c uit_2007/1387P RE CE DE NT I AL
UN I TED STATES CO UR T OF A PP EALS F O R T H E T H IR D C IR C U IT

N os . 05- 4952 and 05- 5112

CA M I L L E De J E S US , I NDI VI DUAL L Y AND A S ADMI NI S T RA T RI X OF T HE E S T AT E OF AL E J ANDR O De J E S US , J R. , DE CE AS E D,

A N D TH E EST A TE O F F E L I CI A L YNNE De J E S US , DE CE AS E D; CH E RY L F AUL K, I NDI VI DUAL L Y AND A S ADMI NI S T RA T RI X OF T HE E S T AT E OF M I CH AE L BR ANDON F AUL K, DE CE AS E D,

AND T HE E S T AT E OF AA RO N A SHA NTI FAU LK, DEC EASED
A ppel l ant s , N o. 05- 5112

v. UNI TE D ST ATE S OF AM ERI CA D EPA RT M EN T O F V ETE RA N S A FFA I RS,
D efe ndant/ T hi r d- Par t yPl ai nt i ff

P HI LADEL P HI A VETE RANS M ULT I

- S ERVI CE & E D U C A T IO N C E N T E R , IN C .;2 LAN DI NG ZON E I I TRA NSI TI ON AL R ESI DEN CE,

T hi r d Par t yD efe ndant
U ni t ed St at es of A m er i ca D epart m ent of V et erans A ffair s, A ppel l ant , N o. 05- 4952

O n A p p ea l from the U n it ed S tat es D istri ct C o u rt f o r th e E a ste rn D istric t o f P e n n sy lv a n ia ( D

. C

. N o. 02- cv- 00253) D i s t r i ctJ udge: H onor abl e Paul S. D i amond

A r gued D ece m ber13, 2006 B efor e: FI SH E R , C H A G A R E S and G R E E N B E R G , C i r cui tJudges

. ( Fi l ed: M ar ch 14, 2007)
W i l l i am G

. C ol e ( A r gued) U

. S. D epart m entof J us t i ce C i vi l D i vi s i on, A ppel l at e St aff 601 D St r eet , N

. W

. , R oom 7409 W as hi ngt on, D C 205303 J oan K

. G arner J oel M

. Sw eet O ffi ce of U

. S. A t t or ney 615 C hes t nutSt r eet , R oom 1250 Phi l adel phi a, PA 19106 A t t or neys f

orAppel l ant

/ C r os s Appel l ee U

. S. D epa rtm ent of

V et erans A f f air s G er al d A

. M cH ugh, J r . ( A r gued) R egi na M

. Fol ey R aynes , M cC ar t y , B i nder , R os s & M undy 1845 W al nutSt r eet , Sui t e 2000 Phi l adel phi a, PA 19103 A tto rn e y s fo r Ap p e llee s/C ro ss Ap

p e lla n ts C am i l l e D eJe s us , etc. , and C her yl Faulk, etc.

OPI NI ON O F THE COURT

F IS H E R , C i r cui tJudge

. T h is case co m es t o u s o n ap p ea l from the D istri ct C o u rt ’s j u d g m e n ti n f

a v o ro f C a m i l l e D e J e s u s ( “ C a m i l l e ” ) a n d C h e r yl Faul k ( “Faul k”) , pl ai nt i ffs and appel l ees i n thi s cas e. Fol l ow i ng a be nc h tr i a l , t he D i s t r i ct C ou r tde t e r mi ne d tha tt he U

. S. D epart m entof V et er ans A ffa i r s ( “the V A ”) w as l i abl e on a theo ryo f gro ss neg li g en ce fo r th e sh o o ti n g d ea ths o f C am il le’s and F aulk’ s chi l dren by C am i l l e’s hu sband , A l ej and ro D eJesus, Sr

. ( “D eJ es us ”) , j us tei ght een hour s aft er he w as r el eas ed fr omA ges ar e att he t i m e of the s hoot i ng. 1 4 a r e s i d e n t i a l h o u s i n g f

a c i l i t y l o c a t e d o n t h e VA’ s g r o u n d s . On appea l , t he V A ar gues t hati thad no s t atut oryorco m m on- l aw d u tyto p ro tec t th e th ird -p a rtyc h ild re n f ro m D e Je su s. C a m ill e a n d F a u lk c ro ss -a p p e a l, cla im in g th e D istric t C o u rt e rre d in g ran ti n g su m m aryjud g m en t t o the V A o n their fa il u re-to-w arn cl ai m s . Fort he r eas on s set for t h bel ow , w e w i l l aff i r m t he ju d g m e n t o f

th e D istric t C o u rt.

I. T he tr agi c factual backgr ound t o t hi s cas e ce nt er s ar ound D eJes us , an honor abl ydi s char ged ex- N avyenl i s t ed man. D eJ es us w as m arr i ed t o C am il l e, w i t h w hom he had thr ee chi l dr en, A l ex, J r . ( age 22) , C andi da (a ge 19), and Fel i ci a ( age 6)

. D eJ es us had a hi s t oryof dom es t i c vi ol ence thatcul m i nat ed 1 i n 1997 w hen C ami l l e obt a i ned a Tem por aryE x Par t e Pr ot ect i on Fr om A bus e O r der r equi r i ng D eJ es us t o s t ay aw ay fr om hi s s on A l ex, J r . forone y ear , fol l ow i ng an i nci denti n w h i ch he a lleg e d lystru c k A le x , Jr. re p e a ted ly . F o llo w in g th e in c id e n t, D eJ es us w as arr es t ed and pl ac ed in j ai l

. W hi l e i n j ai l , he at t empt ed t o hang hi m s el f byhi s sh o elac es . A ft erhe w as r el eas ed, D eJ es us h ad n o hom e t o w hi ch t o r eturn and bega n l i ving on t he st reet , occasi on al l yvis i t i ng ho m el ess s helt ers . I n S e p t e mb e r1 9 9 7 , De J e s u s v o l u n t a r i l ye n t e r e d t h e VA D o m icilia ryP ro g ra m a s an u n e m p lo y e d , h o m e les s v e ter a n w ith s ubs t ance abus e pr obl ems. T he D om i ci l iary P rogr am i s an i npat i ent pr ogr am des i gned t o hel p vet er ans w i t h t he pr oces s of m ovi ng fr om hom el es s nes s and unem pl oym entt o bei ng act i veL abil i t yr efe r s t o emot i onal extr emes – s m i l i ng atone 2 m i nut e fol l ow ed byan i m m edi at e s hi ftt o s obbi ng. 5 m em b ers of the w o rk fo rce . M o st p ati en ts in th e D o m ici li ary Pr ogr am spend appr oxi m at el y 90- 120 day s i n t he pr ogr am and th e n a ttem p t to tra n sitio n b a c k in to th e c o m m u n ity . It i s cons i dere d the l eas tr es t r i ct i ve means of i npat i entt r eatm entat t h e VA. A tt he t i m e he ent er ed t he D om i ci l i aryPr ogr am, D eJ es us w as i ni t i al l yeval uat ed byD r . E dw ar d M oon, a cl i ni cal ps y chol ogi s tw or ki ng att he V A

. D r . M oon’ s eval uat i on found th a t D e Je su s h a d a h isto ryo f d o m e stic v io len c e , an d , w h ile D eJ es us had deni ed depr es s i on, he admi t t ed s adnes s and b o rde red o n labili ty w h en sp ea k ing o f h is estran g ed fa m il y . In 2 addi t i on, D eJ es us i ndi cat ed t o D r . M oon thatw hi l e he w as not curr ent l ys uffe r i ng fr om anyhom i ci dal ors ui ci dal t hought s , he p re v io u slyh a d th o u g h ts a b o u t h u rtin g o th e rs a n d p re v io u sly at t empt ed s ui ci de. D r . M oo n ’s re por tal s o s ugges t ed that u n em p loym en t and h o m elessn ess w ere “tri g g ers” fo r D eJe su s’s d estruc ti v e o u tbu rst s. D u ri n g h is t im e a t th e V A D o m ici li ary Pr ogr am, D eJ esu s rep or t ed t o a ca s e managert hathe w as conce r ned bec aus e he ha d k il l ed a man w hen i n V i etnam and fel tnot hi ng w hi l e doi ng s o. B as ed on thi s i nform at i on, D r . M oon bel i eved t h at D eJ es us had i nt erm i t t entexpl os i ve di s or der

. A ccor di ng t o t r i al t es t i m ony , “[i ] nt erm i t t ent expl os i ve di s or der i s a di s or derw hi ch i nvol ves s om e di s cr et e i nci dent s of ei t herdest ruc t i on or viol ence, tho se i ncident s ar e disp rop ort i on at e t o the st i m ulus, and thos e i nci dent s do notoccuror ar e notbet t erexpl ai ned by6 a n o th e r d ia g n o s is , s u c h a s a n tis o c ia l p e rs o n a lity d is o rd e r . . . .” Ind ividu als su ff

ering fro m in te rm ittent ex p losive d isord er a re g e n e ra llyn o t v io len t b e tw e e n e p iso d e s, o n lyo c c a sio n a lly exhi bi t i ng vi ol ence ori m pul s i venes s ata l ow l evel

. Fol l ow i ng vi ol ent ep isodes , t hos e w i t h t he di s or deroft en exhi bi ts i gns of cal m and r emors e. Per s ons w i t h i nt erm i t t entexpl os i ve di s or der r e p e a t e d l yr e a c tt o t he s a me s t i mu l i a n d d i s p l a yth e s a me r es pons e i n eac h vi ol entepi s ode. Fol l ow i ng t hi s pr el i m i naryeval uat i on by D r . M oon, D eJ es us s aw a V A ps y chi atr ist , D r . Saul G l as ner , w ho confi r med D r . M oon’ s i ni t i al di agnos i s of i nt erm i t t entexpl os i ve di s or der

. D r . G l as nerpr es cr i bed t w i ce- dai l y dos es of 200 m g of T egr e t o l , a n a n t i

- c o n v u l s i v e me d i c a t i o n whi c h h a s b e en s u c c e s s f u lly u s e d to c o n tr o l in te rm itte n t e x p lo s iv e d is o rd e r. A s econd V A ps y chi atr i s t , D r . T i r s o V i nueza , found thatD eJ es us w as s uffe r i ng fr om m i l d depr es s i on and w oul d be see n on an “a s neede d bas i s . ” B eca us e D r . V i nueza w as noti nform ed that D eJesu s w as on T egr et ol and di d notr ead D eJ es us ’ s chart , he w as unaw ar e of D r . G l as ner ’ s di agnos i s of i nt erm i t t ent e x p lo siv e d iso rd e r. N o m e d ica tio n w a s p re sc rib e d f o r th e m ild depr es s i on. T her e i s no i ndi cat i on i n t he re co rd tha tD eJ es us ev er sa w an o ther p sy ch iatri st d u ri n g h is stay at th e D o m ici li ary P r o g r a m. A ft erhi s ps y chi atr i c eva l uat i on, D eJ es us w as as s i gned a “tea m ” tha t w o u ld h e a d u p h is trea tm en t atthe D o m ici li ary P rogram , incl ud i ng psy cho t herapyand subst ance a bu se cou nsel i ng . A l t ho ug h she w as n ot D eJesus’ s ori ginal case mana ge r( a l s o c a l l e d h i s pr i marythe r a pi s t ) , D e ni s e O ut zs-O ut zs - C l evel and has a R egi s t er ed N ur s i ng degr ee, but 3 does nothave a l i cens e t o pr act i ce a s s he h as tw ice fai l ed the lice n sin g e x a m . O u tzs -C lev e lan d d o e s n o t h a v e a lice n se to p ra c tice th e ra p ye ith e r, as th e V A d o e s n o t re q u ire it. 7 C l evel and ca m e t o t ake ove rthatpos i t i on. D ur i ng hi s t i m e at 3 t he D om i ci l i ary Pr ogr am, D eJ es us att ended gr ou p ther apy s es s i ons heade d byO ut zs - C l evel and and unde r w ent ther apyat one- on- one s es s i ons . A tno t i m e dur ing h er m anage m entof D e Je su s ’ s c a se d id O u tzs -C lev e lan d f a m ili a riz e h e rse lf

w ith D eJ es us ’ s m ed ical hi s t oryorbecome aw ar e thathe had be en di agnos ed w i t h i nt erm i t t entexpl os i ve di s or der

. I n addi t i on, des pi t e the fa ctt hatO ut zs - C l evel and w as tr eat i ng D eJ es us for s u b s t a n c e a b u s e p r o b l e m s , s h e w a s n e v e r a w a r e o f w h a t , i f a n y, m edi cat i ons he w as on. A f ter D e Je su s c o m p lete d a p p ro x im a telyf o u r-a n d -a -h a lf m ont hs i n t he D om i ci l i aryPr ogr am, O ut zs - C l evel and rec o m m en d ed h im fo r pla c e m e n t i n L an d ing Z o n e II T r ans i t i onal R es i dence ( “LZ

- I I ”)

. L Z

- I I i s a pr ogr am of t he P h il ad elp h ia V eteran ’s M u lt i- S erv ice a n d E d u ca ti o n C en ter, w hich serves as a tr ans i t i onal pr ogr am for ve t er ans w ho m ay liv e a n d w o rk a t L Z -II f o r u p to tw o y e a rs. L Z -II is a p riv a tely run, no n-profi t organizat i on t hat i s fu nd ed by t he V A H om el ess G r antand PerD i em P r ogr am. I ti s l ocat ed on t he gr ounds of the V A M edi cal C ent eratC oat es vi l l e i n a bui l d i ng ow ned byt he V A

. A s par tof i t s gr ant t o L Z

- I I , the V A pr ovi des al l m edi cal and ps y chi atr i c s ervi ces t o L Z

- I I r es i dent s , i n cl udi ng ar oundt he-cl ock em ergency m edical and psy chiatri c care. T he V A al so p rov ides fu ll -t im e p o li ce an d fire service s. L Z -II staff m em b ers8 regul arl ycon sul tw i t h V A case m anag ers and m ental h e a lth w orkers regar ding t he resi den t s. R esi den t s atL Z -I I are subj ect t o a n um ber of restri ct i on s. W h ile th e y m a ylea v e th e re sid e n c e , the ya re re q u ire d to sig n in a n d o u tand m ustprovide an acc ou nt of theirw hereabo uts

. L Z -II reside n ts m ayn o t kee p alco h o l i n their roo m s, w h ich a re s ubj ectt o s ear ch byL Z

- I I atanyt i m e i f t he faci l i t ydeems s uch a se arc h n ec essa ry . L Z -II co n d u cts w ee k lyinsp ec ti o n s o f e v ery r e s i d e n t ’ s r o o m. W h il e a t L Z -II , D eJe su s p arti cipa ted in a v o lun tary aft er car e pr ogr am, dur i ng w hi ch t i m e O ut zs - C l eve land w as avai l abl e t o hi m for cont i nued t her apy . A tt he t i m e D eJ es us w as a d m itt e d to L Z -II, O u tzs -C lev e lan d h a d p e rm iss io n to re lea se to L Z -II a ll p e rso n a l in f

o rm a tio n re g a rd in g D e Je su s th a t sh e h a d in h e rp o s s e s s i o n , i n c l u d i n g h i s m e d i c a l a n d p s yc h i a t r i c h i s t o r y. D es pi t e t hi s perm i s s i on, O ut zs - C l evel and neverr el eas ed anyof this i n fo rm ati o n to L Z -II

. In fa ct, o n h er rec o m m en d ati o n fo rm forL Z

- I I , O ut zs - C l e v e l a n di n d i c a t e dthatD eJ es us had no ment al heal t h i s s ues or behavi or al pr obl ems, des pi t e t he evi dence i n the V A r ecor ds thatD eJ es us had i nt erm i t t entexpl os i ve di s or derand suffered from viol ent outbu rs t s and suici dal i deati on s. O n N ov em ber 10, 1998 , D eJesus contact ed O utzs

C leve land a n d in fo rm ed h er tha t he w as e n g ag ed in co u rt pr ocee di ngs t o s eek pa r t i al cus todyof or , atl eas t , vi s i t at i on r i ght s forhi s y oungerdaught er , Fel i ci a. A t tha tt i m e, he i ndi cat ed thathi s es t r anged w i fe w oul d notal l ow hi m any c o n tac t w ith h e r, an d th a t h is p rio r a b u siv e b e h a v io r h a d led h is o l d e rc h i l d r e n , Al e x , J r . a n d Ca n d i d a , t o a v o i d c o n t a c twi t h h i m. O n J anuary15, 1999, D eJ es us t ol d O ut zs - C l evel and t hat he w as9 “[g] et t i ng qui t e frus t rated w i t h t he court

. ” D es pi t e a l ett er O ut zs - C l evel and w r ot e t o t he fami l y cour t , D eJ es us s t i l l had not gai ned cus t ody over hi s daught erand, i n addi t i on, C andi da and hi s w i fe ha d s een hi m ata cus t ody hear i ng but r efus ed t o s peak t o hi m . H e expr es s ed hi s gr at i tude t o O u tzs- C l evel and thathe w a s “ in th is f

a c ilityto v e n t h is f

e e lin g s a n d m a in tain h is s o b ri e ty.” O n Febru a ry1 2 , 1 9 9 9 , O ut zs - C l evel and r ece i ved a phone cal l from a m an request i ng t o speak t o C am i l l e. O utzs

C l evel and r ecogni zed D eJ es us ’ s voi ce and re al i zed t hathe had m i s t akenl y cal l ed her w hi l e tr y i ng t o cont acthi s es t r anged w i fe. H erl og entr yfol l ow i ng t he conve r s at i on r ead: Phone r ang ar ound 1500 [hours] and the per s on o n t h e o t h e re n d a s k e d f o rCa mi l l e . Re s ponded s ay i ng they had the w r ong num berand then r e c o g n ize d th e v o ice to b e f a m ili a r. A sk e d if

it w as A

. D eJ es us and thi s vet er an r es ponded,

“ Y e s.” M r. D e Je su s w a s try in g to c a ll M e d ia to c o n t a c th i s e s t r a n g e d w i f e a n d h a d s o m e [ h o w] cal l e d th e 7A do [r] m . L earned thathe h ad just been served his d iv o rc e pap ers and he w as very dis tr aughton t he phone. T al ked br i efl yand as ked h i m t o s e e u n d e rs ig n e d

[O u t zs - Cl e v e l a n d

] AS AP to p ro c e ss h is f

e e lin g s a n d talk

. H e sa id h e w o u ld cal l back. (Em ph asi s added

. ) D eJesus never cal l ed b ack an d O utzs

C l evel and neve runder t ook anyfol l ow - up. O n M ar ch 22, 1999, D eJ es us w as w or ki ng i n t he ki t chen atL Z

- I I , pr epar i ng br eakf as tw i t h otherr esid ent s . D eJ es us10 e n ter e d in to a v e rb a l c o n f ro n tatio n w ith a n o th e r L Z -II re sid e n t, B i l l Q ueen , ov er a di rtybu cket of w a ter

. W hil e res i den t s’ ver s i ons of the eve nt s di ffe r ed, a ll agr eed thatats om e poi nt dur i ng t he al t er cat i on, D eJ es us pi cked up a kni fe, hel d i tbehi nd h is b a c k , an d Q u e e n f

e lt th r e a ten e d . T h e k n if e in c id e n t o n ly last ed a m att er o f m inu tes, an d , w h il e D eJe su s d id n o t i n jure any on e, t he k nife had to be fo rci blyrem ov ed from his han ds. A ft erthe al t er cat i on, L Z

- I I cont act ed O ut zs - C l evel and a n d Bru c e Newe l l , Que e n ’ s t h e r a p i s t , t o d i s c u s s t h e s i tu at i on. T h e V A rec o m m en d ed that D eJe su s b e d isch arg ed

. W h il e L Z -II claim ed itw as u n d er n o o b li g ati o n to f o ll o w the V A ’s re c o m m e n d a tio n re g a rd in g h is d ism iss a l f ro m th e p ro g ra m , it r el i ed hea vi l yon t he V A s t aff’ s advi ce a nd w oul d nothave di s m i s s ed D eJ es us but

- forthe V A ’ s r ecomm endat i on. D eJ es us w as i nvol unt ari l ydi s char ged fr om t he LZ

- I I pr ogr am for

“ c re a tin g a p h y sic a l th r e a t w ith a w e a p o n .” A f ter h e w a s to ld th a t h e w o u ld b e d isc h a rg e d f ro m L Z -II, D e Je su s w a s “ q u iet” and sa id h e w ou l d leave. B efore he left , D eJesus m etO utzs

C lev e lan d , s a id th a t h e lo v e d h e r, g a v e a w a ya n u m b e r o f h is p e rso n a l p o ss e ss io n s, and i nf o rm e d se v e ra l p e o p le th a t h e w o u ld be w al ki ng t o M ai ne orN ew H ampshi r e. A tt hi s t i m e, O u tzs

- C l evel and expr es s ed conc ern over D eJ es us ’ s m ent al w el l

- bei ng and off er ed tw i ce t o t ake D eJ es us t o s eek a ps y chi atr i c eva l uat i on. H e decl i ned bot h t i m es . A ft er D eJe su s d ec li n ed to b e se en , O u tzs-C leve land co n tacted D r. S t e p h e n Ch a mb e r s a n d Dr

. Ch r i s t o p h e rRa y , two VA p sy ch o log ist s, to inq u ir e a s to w h e th er sh e c o u ld req u ir e D eJ es us t o s eek c ouns el i ng befor e he l eft

. D es pi t e t he exi s t ence o f in v o lu n tar yc o m m itm e n t p ro c e d u re s a t th e V A , the yb o th i nform ed hert hathe coul d notbe for ced t o be s een be caus e he11 w as an outpat i ent

. H ow ever , w hen s he as ked them, s he di d not i nform t hem t hatD eJ es us w as gi vi ng aw ay hi s pos s es s i ons or i nform t hem abouthi s p ri o rhi s t oryof dom es t i c abus e and s u i c i d a l i d e a t i o n s , o f

t e n t r i g g e r e d bya c h a n g e i n j o b o rh o me s i tuat i on. H ad s he i nform ed hi m of t hat i nform at i o n , D r. C hambers be l i eved he m ayhave s ugges t ed s he have D eJ es us i nvol unt ar i l ycomm i t t ed. I n her w r i t e- up fol l ow i ng t he i nci dent , O ut zs - C l evel and w r ot e: [ D e Je su s] d id n ’t q u ite u n d e rsta n d o r re f u se d to u n d e rsta n d th e se rio u sn e ss o f p ick in g u p th is kni fe t o us e as a w eapon. H e w as offe r ed tw i ce d u r in g m e e tin g to b e e sc o rte d o v e r to B ld g 2 to o u tp a tien t to h a v e a S T A T P sy c h iatric C o n su lt. M r . D eJ es us di d notw antt o ut i l i ze thi s offe rof s up p o rt and j us ts ai d he w oul d l eave t odayaft er h e g av e a fe w o f h is i tem s aw ay to cu rren t L Z -II r es i dent s . H e st at ed he w oul d be w al ki ng t o N ew H am p sh ir e or M aine

. C oncern ar os e by un dersi gn [ed] f or him t o b e seen d u e t o h is past h isto ry o f w a n tin g to h u rt oth e rs , p a rtic u la rly h is es tr anged w i

f e w ho r ece nt l

y s er ved hi m di vor ce pa pers andha s not al l ow ed co ntactw i th yo un gest daught erf

orovera year
. He is i n a cus t ody b a ttl e w ith w ife. He h a s a lso in p a st h a d th o u g h ts o f h u rtin gse lf. ( E m phas i s added. ) A tno poi nt on M ar ch 22 di d D eJ es us m ake anys peci fi c thr eat s agai ns thi s w i fe orchi l dr en.Th e P h i l a d e l p h i a Ve t e r a n s M u l t i

- S e rv i c e Ce n t e ra n d LZ- 4 II a re n o t p a rticip a tin g in th is a p p e a l. 12 Fol l ow i ng D eJ es us ’ s r el eas e fr om L Z

- I I , t he LZ

- I I s t aff conduct ed a s ear ch of D eJ es us ’ s r oom and found thathe had s hr edded much of hi s cl othi ng, i ncl udi ng a base bal l cap thatw as o f p a rt ic u la r im p o rta n c e to h im . D e sp ite th e f a c t th a t th is behavi ori s cons i s t entw i t h s ui ci dal t endenc i es , no one w ho w as c a lled to c o n su lt th o u g h t to m a k e u se o f P e n n sy lv a n ia in v o lu n tar yc o m m itm e n t p ro c e d u re s o r e m e rg e n c yp sy c h iatric i nterven t i on un der the V A ’s i nternal pr oced ures. D eJ es us l eftL Z

- I I s om et i m e on the af t ernoon of M arc h 22. A ppr oxi m at el yei ght een hour s l at er , on M ar ch 23, D eJ es us char ged thr ough the doorof C ami l l e’ s apart m entand s h o tt wo o f

t h e i rc h i l d r e n , Al e x , J r . a n d F e l i c i a , a n d t wo n e ig h b o r c h ild re n , A a ro n F a u lk a n d M ic h a e l F a u lk . A le x , J r., Fel i ci a and A ar on Faul k di ed i m m edi at el y . M i chae l Faul k di ed t w o day s l at er i n t he hos pi t al

. A ft ers hoot i ng the fourchi l dr en, D eJ es us tur ned the gun on hi m s el f. U pon hear i ng aboutan i nci denti nvol vi ng a man ki l l i ng hi s chi l dr en and then hi m s el f on t he n ew s, O utzs -C l eveland im m ediat el yt ho ug ht i tw as D eJesus. II. O n Ja n u a ry1 6 , 2 0 0 2 , C a m ill e a n d F a u lk in stitu ted a su it agai ns tt he U ni t ed St at es , t he V A , t he Phi l adel phi a V et er ans M u l t i

- S e r v i c e Ce n t e r , a n d LZ

- I I u n d e r t h e F e d e r a l To r tCl a i ms 4 A c t (“ F T C A ” ) i n d iv id u a lly a n d o n b e h a lf o f th e e sta tes o f

th e ir chi l dr en fort he M ar ch 23 dea t hs

. T he C om pl ai nti ncl u d ed cl ai m s for : ( 1) T he V A ’ s gr os s negl i gence i n di s char gi ng or13 f a ili n g to tre a t D e Je su s w h e n h e w a s a n im m in e n t th re a t, ( 2) fai l u r e t o w arn, ( 3) w r ongful death and ( 4) negl i gent i nfli ct i on of em oti on al dis t res s. T h e D istri ct C o u rtg ran ted th e V A ’s m o ti o n fo r sum m ary j udgm en t on t he pl ai nt i ffs ’ fai l ur e- t o- w arn cl ai m s on February17, 2005, fi ndi ng that a ment al heal t hcar e pr ovi der o n lyh a s a d u tyto w a rn if a “ p a tien t co m m u n ica tes a sp e c if ic a n d i m m ediat e t hreat of ser i ou s bo dil y i njury against a s p e c if ic a lly id e n tif

ie d o r re a d ily id e n tif ia b le th ir d p a rt y .” F o ll o w ing the co n clus ion o f p re-tr ial m o ti o n s, the D istri ct C o u rt h e a r d t h e r e m a i n i n g c l a i m s w i t h o u ta j u r y. A t tri a l, th e p lai n ti ff

s p rese n ted a n ex p ert, D r. R o b ert L l oy d G ol ds t ei n, w ho t es t i fi ed thatD eJ es us ’ s behavi orl eadi ng up t o t he s hoot i ngs w as verycons i s t entw i t h s om eone s uffe r i ng fr om i nt erm i tt en texpl os i ve di s or der

. H e s t at ed thatthe phone c a l l t o Ou t z s - Cl e v e l a n d i n d i c a t e d t h e b e g i n n i n g o f a c r i s i s . He fur ther testi fi ed thatthe i nci dentw i t h t he kni fe w as a s i gn of decompens at i on ( ordet er i or at i on)

. D eJ es us ’ s di agno sis as h a v in g in ter m itt e n t ex p lo siv e d iso rd e r “ in d ica ted

. . . h is pr o p en sityt o have e xpl os i ve outbur s t s . . . U nderthe ci r cumst ance s i tw as cert ai nl ys om ethi n g t o paus e and be conce r ned about

. ” I n s i tuat i ons l i ke t he one pr es ent ed fol l ow i ng th e k n if e in c id e n t, D r. G o ld ste in sta ted th a t itis im p e r a tiv e to t ake i nt o acc ounta pat i ent ’ s h ist o r yw hen maki ng t r eatm ent d e c isio n s. H e b e liev e d th a t th e V A g ro ss lyf a iled in its d u tyin t his reg ard as no one w as fami l i arw i t h D eJ es us ’ s ful l m edi cal hi s t or yw hen s om eone s houl d have be en. D r. G oldst ei n al so t est i fi ed that , un der the cir cum st ances, D eJ es us s houl d nothave be en r el eas ed. H i s w i l l i ngnes s t o gi ve14 aw ayhi s per s onal bel ongi ngs i ndi cat ed a pr opens i t yfors ui ci dal b e h a v io r. F u rth e r, a n y o n e f a m ili a r w ith D e Je su s’s ten d e n c yto have vi ol entoutbur s t s aft erfac ing frus t r at i on i n hi s hom e or w ork l i fe sho uld h ave kn ow n thatt o ex pel hi m from L Z -I I w as, in e f f e c t, t o e x p e l h im f

ro m h is jo b a n d to c o m p lete lyiso late h im f ro m h is s u p p o rt sy ste m n o t lo n g a f ter h e lea rn e d h e w o u ld be get t i ng di vor ced. D r . G ol ds t ei n s t at ed thatt o do s o w oul d be t o t ake s om eone w ho i s al r eadyi n cr i s i s and s er i ous l ycompound t hatcr i s i s . T he fa i l ur e t o s har e r eadi l y - avai l abl e i nform at i on, t he fai l ure t o corr ect l y recogn i ze D eJesus’ s sui ci dal t end encies , a n d th e fai l ure t o p reventD eJesus’ s r el ease con st i tuted gross negl i gence . T he V A al s o pr es ent ed an expertw i t nes s , D r . B r ooke Z i t ek, w ho t es t i fi ed r egar di ng i nvol unt aryco m m i t m ent pr oc e d u r e s i n Penns y l vani a. She t es t i fi ed thatm os tpat i ent s w ho are inv o lun tari lyco m m itted a re su ff ering fro m m u ch m o re se v e re p sy c h o tic e p iso d e s th a n D e Je su s. “ [ T ]h e p e rso n is to tally l acki ng in term s of thei r[s i c] j udgm entand thei r[s i c] i ns i ght into the ir[sic] il lnes s. ” S h e d id n o t b eli ev e tha t D eJe su s’s behavi ordur i ng t he kni fe i nci dentcr eat ed a “ cl earand pr es ent dan ger” as r equ i red byP enn sy l van i a com m i t m ent pr oced ures. O t hert han the February4 phone ca l l and the M ar ch 22 kni fe i nci dent , D r . Z i t ek di d not bel i eve t hat D eJ es us had ex h i bi t ed anybehavi ort hati ndi cat ed a s er i ous demeanorchange

. O n cr os s exami nat i on, D r . Z i t ek admi t t ed that , of the f a c to r s typ ic a ll y c o n s id e r e d in d e te r m in in g w h e th e r a p sy c h iatric em ergencyexis t ed, al l of them app l i ed to D eJesus. D eJesus al so exhi bi t ed s ever al s i gns i ndi cat i ng a t endenc yt o w ard sui ci de. S h e a l s o t e s t i f

i e d t h a t“ i d e a l l y t h e th e r a p i s two u l d h a v e k n o wn [D eJ es us ’ s ] di agnos i s. ” H ow ever , D r . Z i t ek mai nt ai ned her15 pos i t i on t hatt he V A di d not gr os s l y devi at e fr om t he s t andar d of car e. I n i t s fi nal deci s i on, t he D i s t r i ctC our ts t at ed thati tfound D r . G o lds t ei n cr edi bl e w hi l e D r . Z i t ek’ s t es t i m onyw as equi vocal and unconvi nci ng. Fol l ow i ng t es t i m ony , t he D i s t r i ctC our tfound s uffi ci ent evi dence t o ent er judgm entagai ns tt he V A , fi ndi ng i tw as gr os s l ynegl i genti n i t s det erm i nat i on t h at D eJ es us s houl d be di s char ged fr om L Z

- I I and i n i t s fai l ur e to comm i tD eJ es us f o llo w in g th e d isc h a rg e . T h e se v io latio n s o f th e a p p r o p ria te s t andar d of car e proxi m at el y caus ed t he shoot i ng deaths of the four c h il d r en. T her efor e, the D i s t r i ctC our taw ar ded damages t o C ami l l e and Faul k i ndi vi dual l y and on behal f of the es t at es of t hei rchi l dr en forgr os s negl i gence and w r ongful death. A ddi t i onal l y , t he D i s t r i ctC our tfound thatC ami l l e had pr oven t he nec es s aryel ement s fornegl i genti n fli ct i on of emot i onal d i s t r e s s a n d a wa r d e d h e ra d d i t i o n a l d a ma g e s o n th a tc l a i m. III

. T h e D istric t C o u rt h a d ju risd ictio n o v e r th is F T C A c laim pur s uantt o 28 U

. S. C

. § 1346( b)

. W e exer ci s e j ur i s di ct i on over t hi s appea l fr om a fi nal j udgm ent of the D i s t r i ctC our tpur s uant t o 28 U

. S. C

. § 1291. W e r evi ew the l egal deci s i ons of a di s t r i ct c o u rt c o n d u c tin g a b e n c h tria l de novo , but“[f ] i ndi ngs of fa ct sh al l not be s et as i de unl es s cl ear l y err oneous and due re g ard m u st b e g iv e n to th e trial c o u rt’s ju d g m e n ts a s to th e c re d ib ili ty of the w i t nes s es . ” C ol l i ers Lanard & A xi l bu n d v. Ll oyds of London , 458 F. 3d 231, 236 ( 3d C i r . 2006 ) ( ci t i ng Fed. R

. C i v. P. 52( a)). B eca us e the l i abi l i tyof the U ni t ed St at es undert he F T C A is d e ter m in e d b yth e law o f th e sta te w h e re th e a lleg e d ly to rtio u s a c t o c c u rre d , 2 8 U .S .C

. § 2 6 4 7 , w e w ill lo o k to th e sta te16 cou rt s to d et erm i ne ho w t o resol ve the un derl y i ng l egal i ssues. If th e re is n o a p p lica b le d e c isio n f ro m th e sta te’ s h ig h e st c o u rt, w e ar e cha r ged w i t h pr edi ct i ng how t hat cour t w oul d r es ol ve the i ssue, con si deri ng “(1) w hat that courthas s ai d i n r el at ed areas; ( 2) t he dec i s i onal l aw of t he s t at e i nt erm edi at e court s ; ( 3) fede r al cas es i nt erpret i ng s t at e l aw ; and ( 4) deci s i ons fr om ot her j ur i s di ct i ons t hathave di s cus s ed the i s s ue. ” I d. ( i nt ernal c itatio n s o m itt e d ). W e “ m u st a ttribu te s ig n if ic a n t w e ig h t to t hes e [l ow ers t at e court ] deci s i ons i n t he abs ence o f any i ndi cat i on t hatt he hi ghes t s t at e courtw oul d rul e otherw i s e. ” I d. B e c a u se th e c o n d u c t in q u e stio n to o k p lac e in P e n n sy lv a n ia, its l aw pr oper l ygoverns thi s act i on. I V. T he pr i m ary i s s ue t hatw e ar e pr es ent ed w i t h i s w hether the V A h ad a d u tyu n d er P en n sy lv a n ia law to p rotec t th e third p arti es w h o w ere k il led w h en D eJe su s w as re lease d fro m L Z -II

. B eca us e C ami l l e and Faul k have c r os s - appeal ed the D i s t r i ct C o u rt’s d e c isio n to g ra n t th e V A su m m a ry ju d g m e n t o n th e ir fai l ur e- t o- w arn cl ai m s, w e begi n ouranal y s i s w i th t he Penns y l vani a S upr eme C our t ’ s deci s i on i n E m er i ch v. P hi ladel phi a C ent erf

orH um an D eve l opm ent

, I nc. , 720 A

. 2d 1 0 3 2 ( P a . 1 9 9 8 )

. Ta k i n g i t s c u e f r o m t he Ca l i f

o r n i a S u p r e me C o u rt ’s l andmar k deci s i on i n Taras of f v. R egent

s of the U n ive rs ity o

f C a lif o r n ia , 551 P. 2d 334 ( C al

. 1978) , t he P e n n sy lv a n ia S u p re m e C o u rt re c o g n ize d th a t, w h ile th e re is g en era ll y n o d u ty to con tr o l the co n d u ct o f a th ir d p arty , w h ere t he def endants t ands i n a s peci al r el ati o n sh i p t o t he vi ct i m or s o m e o th e r p a rt y , th e v ic tim d e s e rv e s p ro te c tio n . E m er i ch , 720 A

. 2d at1037. T her ef

o re, t he C our thel d thatw hen a ment al heal t h pr ofes s i onal det erm i nes t hat her pat i ent pr es ent s a s er i ous17 dangerof vi ol ence t o an other , thatm ent al heal t h pr ofes s i onal h a s a n a f f ir m a tiv e d u ty to w a rn th e in te n d e d v ic tim

. I d. at1039- 40. H o w e v e r, re c o g n izin g th a t to re a d th a t d u tyto o b ro a d ly w oul d r es ul ti n cr i ppl i ng an al r eadyheavi l y - bur dened pr ofes s i on, the Penns y l vani a Sup rem e C o u rtca ref u ll yd eli neat ed its app l i cat i on . B efore a m ental health provi der has a du tyto w ar n o ro t h e r wi s e p r o t e c ta th i r d p a r t yf r o m a th r e a tp r e s e n t ed by a pat i ent i n her car e, t he t hr eat m us t be a s pecific and im m e d iate th re a t o f

se rio u s h a rm , a n d th e v ictim m u st b e re a d ily id e n tif ia b le

. I d. at1041. I n t hei rcros s - appea l , C ami l l e and Faul k m ake a novel ar gum ent r egar di ng w hy t he V A had a dut y t o w arn C ami l l e of h er h u sb an d ’s be h av ior. H o w ev er, th is i s a c lear ca se w h ere E m er i ch does not appl y . C ami l l e and Faul k agr ee t hatt her e w as no s peci fi c thr eatof i m m edi at e harm m ade a gai ns tC am i l l e or herchi l dr en bef

or e D eJ es us l eft L Z

- I I

. R ather , t heyar gue that beca us e O ut zs - C l evel and w r ot e a l ett er t o t he fami lyco u rt at t es t i ng t o D eJ es us ’ s i m pr oved ment al heal t h, the V A then had a dutyt o i nform anyper s on w ho m ayhave r el i ed on t hatl ett er i f D eJ es us ’ s m ent al heal t h s t at e cha nged. H ow ever , t he out come of cour tpr ocee di ngs can a ffe ctnum er ous par t i es , and i tw oul d be very di ffi cul t t o i dent i fy al l per s ons w ho w oul d have re lied o n O u tzs -C lev e lan d ’s le tter. B e c a u se o f th e P e n n sy lv a n ia S u p r e me Co u r t ’ s n a r r o w r e a d i n g o f f a i l u r e - t o - wa r n c l a i ms , we do not bel i eve t hat , gi ven t he oppor tuni t y , i t w o u ld expandW e a l s o n o t e th a tCa mi l l e ’ s a n d Fa u l k ’ s r e l i a n c e on 5 C i pr i ani v. Sun P i

pel i ne C o. , 5 7 4 A .2 d 7 0 6 (P a . S u p e r. C t. 1990) , and Schw ar t

zv. U ni t ed Stat es , 2 3 0 F

. S u p p . 5 3 6 ( E

. D. P a . 1 9 6 4 ), is m isp lac e d . In b o th c a se s, th e c o u rt f o u n d th a t a d e f e n d a n t w h o h a d c re a ted a risk o f h a rm w a s u n d e r a d u tyto p re v e n t th a t h a rm f

ro m ta k in g e f

f e c t. C i pr i ani r el i ed on Sect i on 321 of t he R es t at ement ( Second) of T or t s , w hi ch pr ovi des that w h ere an ac to r h a s c re ated a risk o f h arm , the a ctor is un d er a dut yt o exer ci s e r eas onabl e ca r e t o pr eventt he r i s k fr om t aki ng effec t. R es t at ement( Second) of Tort s § 321. W hi l e the Penns y l vani a Supr eme C our thas neveradopt ed Sect i on 321, G l i ck v

. M

ar t i n & M

ohl er, I nc. , 5 3 5 A

. 2 d 6 2 6 , 6 2 9 (P a. S u p er. C t. 19 8 7 ), ev e n if

it h a d , this c a se w o u ld n o t b e a n a p p ro p ria te Sect i on 3 2 1 act i on. U nl i ke the pl ai nt i ffs i n C i pr i ani and Sc h w a rtz , t he part i es w ho w er e l i kel yt o be af fec t ed byO ut zC l evel and’ s l et t er t o t he fa m i l ycourtar e noteas i l yi dent i fi abl e. T o us e Sect i o n 3 2 1 to expand the l i m i t ed dutyi n E m er i ch to cas es w her e an a ffi r m at i ve s t at ementby a m ent al heal t h w or ker m ay aff ects om e uni dent i fi ed party w o u ld i m pos e a va gue and u n w o rk a b le sta n d a rd

. A s the C a lifo rn ia S u p re m e C o u rt sa id in T a ra so ff , appl i cat i on of S ect i on 321 l i abi l i t y i n s i tuat i ons s uch a s th is ra ise s “ d if

f icu lt p ro b lem s o f

c a u a stio n a n d o f

p u b lic pol i cy . ” T

aras o ff , 551 P. 2d at349 n. 18. T her efor e w e do not b e liev e th e P e n n sy lv a n ia S u p re m e C o u rt w o u ld im p o se liab ili ty o n th e V A b a se d o n S e c tio n 3 2 1 o f th e R e sta tem e n t. 18 E m er i ch to a situat i on thati nvol ves no s peci fi c thr eatof i mme d i a t e h a r m a g a i n s ta r e a d i l yi d e n t i f i a b l e v i c t i m. 519 V. A s th e D i stri ctC ou rtdid not base i t s j ud gm ent agai nst t he V A on a fa i l ur e- t o- w arn cl ai m , w e nextaddr es s w hether Ca mi l l e a n d F a u l k a p p r o p r i a t e l yr e c o v e r e d b e c a u s e th e VA o w e d a d if

f e re n t d u tyto th e ir c h ild re n . In a ll t o rt c a se s, a d u ty m ay be i m pos ed ei t herthr ough comm on- l aw cas e deve l opm ent o r t h ro u g h s ta tu te

. Emer s o n v
. Ad u l tCm t

y
. To ta lS e r vs
. , I

nc. , 8 4 2 F . S u p p . 1 5 2 , 1 5 5 (E .D . P a . 1 9 9 4 ); see S erbi n v. Z i eba rt Intern. C or

p. , I nc. , 11 F. 3d 1163, 1167- 68 ( 3d C i r . 1993) ( l ooki ng t o both s t atut e and c om m on l aw t o det erm i ne exi s t ence o f a d u ty ). W e th e re f

o re lo o k to b o th k in d s o f d u ties to d e t e r mi n e t h e s c o p e o f t h e VA’ s d u t yt o t h e t h i r d

- p a r t yv i c t i ms i n the case befo re us. A. W hi l e t h e Pe n n s y l v a n i a Su p r e me Cou r th a s n ot sp ec ifi ca ll yad d resse d the c o m m o n -l aw d u tyto p rotec t th ir d p a rties in situ a tio n s o th e r th a n f a ilu re to w a rn , th e P e n n sy lv a n ia Super i orC our thas t w i ce s t at ed t h att her e i s no comm on- l aw dut yt o pr ot ect t hi r d par t i es i n s i tuat i ons l i ke t he one pr es ent ed her e. I n F

. D

. P

. v. Ferr ara , 8 0 4 A .2 d 1 2 2 1 (P a . S u p e r. C t. 2 0 0 2 ) , t h e p a r e n t s o f

a g i r l w h o w a s s e x u a l l y a s s a u l t e d b y a r es i dentof a m en tal heal t h fac i l i t ybr oughts ui tagai ns tthe o p e ra to rs o f

th a t f a c ility. T h e ya lle g e d , in tera lia , thatthe m e n tal h e a lth f

a c ili tyw a s n e g lig e n t in f a ili n g to se e k a c iv il comm i t m en t o f the r es i dent , w ho had a l ong hi s t oryof s exual m is c o n d u c t. I

d. at 1 2 2 5. T he courtfound thatt her e w as no gener al dut yt o contr ol the conduc tof a thir d par t yt o pr ot ect anotherfr om harm “unl es s t her e i s a s peci al r el at i ons hi p . . . t hat im p o ses a d u tyu p o n the a c to r t o co n tr o l th e third p erso n ’sT hese co nsi derat i on s i nclude: “‘( 1) the rel at i on sh ip 6 b e tw e e n th e p a rties ; ( 2 ) th e so c ial u til ity o f th e a c to r’s c o n d u c t; ( 3) t he natu re o f the r i s k i m pos ed and the for es eea bi l i t yof the harm i ncurr ed; ( 4) t he cons equenc es of i m pos i ng a dutyu pon t he act or ; ( 5) t he over al l publ i c i nt er es t i n the p ropos ed s ol ut i on. ’ ” F e rrara , 804 A

. 2d at1231 ( quot i ng B r is bi ne v. O ut s i de i n Sch. of

E xper i ent i alE duc. , I

nc. , 799 A

. 2d 89, 95 ( Pa. S u p er. C t. 2 0 0 2 )). 20 conductorunl es s t her e i s a s peci al r el at i on b etw een the ac t or and the other

. . . . ” I

d. at1228. N o s uch dutyexi s t ed as t o t he fac i l i t y . Fur t her , t he cour t decl i ned t o adopt Sect i on 319 of the R es t a t e me n t , whi c h i mpo s e s a d u t yt o p r e v e n ta t h i r d

- p er s on fr om doi ng harm o n “[o] ne w ho t akes char ge of a thi r d per s on w h o m h e k n o w s o r sh o u ld k n o w to b e lik e lyto c a u se b o d ily h a rm to o th e rs if

n o t co n tro lled .” R e sta tem e n t ( S e c o n d ) T o rts § 3 1 9

. B ase d o n b alan cing p o li cyco n side rati o n s, the c o u rt 6 s t at ed: I f w e al l ow r ecove r yagai ns tm ent al heal t h and m ent al r et ard at i on pr ovi der s forharm caus ed by p a t i e n t s e x c e p t i n th e c l e a r e s tc i r c u ms t a n c e s , we wo u l d p a r a l y z e a s e c t o ro f s o c i e t y t ha t p e r f

o r ms a val uabl e s ervi ce t o thos e i n n ee d of m ent al heal t h car e. T hus , w e decl i ne t o i m pos e a dut yof or di narycar e u nderR es t at ement( Second) of T o rts [S e c tio n ] 31 9 o n p ro v id e rs o f m e n tal h e a lth and m ental ret ardat i on services

. I d. a t 1 2 3 2 ; s e e a l

s o He i lv
. Br o wn , 662 A

. 2d 669, 671 ( Pa. Super

. C t

. 1995) (refu s i ng t o fi nd comm on- l aw dut yw her e aD i ct a i n E m er i ch su g g e sts th a t th e re m a y b e a d u ty 7 g r e a t e rt h a n s i mp l yt h e d u t yt o wa r n . F o re x a mp l e , t h e S u p r e me C o u rt in d ica ted th a t m e n tal h e a lth c a re p ro f e ss io n a ls m a in tain a s p e c ia l re la tio n s h ip w ith th e irp a tie n ts

. E m er i ch , 720 A

. 2d at 1037. It also r efe r r ed t o Sect i on 319 of the R es t at ement ( Second) of Tort s , w hi ch i tci t ed “w i t h appr oval ” i n i t s deci s i on i n G oryeb v. P enn sylvan i a D epa rtm ent of P ub l i c W

el f are , 575 A

. 2d 545, 549 ( Pa. 1990)

. W hi l e thi s di s cus s i on i ndi cat es that t he Penns y l vani a Supr eme C our ts ees s om e val ue i n i m pos i ng a d u tyto co n tr o l dan g ero u s p ati en ts on m en tal h ea lth ca re pr ovi der s w ho t ake c har ge of thes e pat i ent s , t her e i s no in d ica tio n th a t th e S u p re m e C o u rt w o u ld e x p a n d su c h a d u tyto s uch an e xt ent a s t o fi nd a comm on- l aw dut yt o comm i ti n a s i tuat i on s uch as t he one pr es ent ed her e. 21 pol i ce office r w as s truck bya vehi cl e dr i ven bya pat i ent re c e iv in g v o lu n tar yo u tp a tien t ca re f ro m th e d e f

e n d a n t h e a lth insti tuti o n ). W e fi nd t hi s r eas oni ng compel l i ng and bel i ev e th a t , g i v en t he oppor tuni t y , t he Penns y l vani a Supr eme C our tw oul d adopt a sim ilar a p p ro a c h

. It is u n lik e lyth a t th e P e n n sy lv a n ia 7 S u p re m e C o u rt w o u ld a d o p t a g e n e ra l co m m o n -la w d u tyto comm i ta pat i ent or ot herw i s e pr ot ectt hi r d par t i es fr om a ment al h e a lth p a tien t ab se n t a s p e c ial re latio n sh ip . T h e re f o re , li a b ili ty c a n n o t b e b a s e d o n a c o mmo n - l a w d u t yo we d t o t h e f o u rv i c t i ms i n t hi s cas e.22 B. H o w ev er, du ti es th at giv e ri se t o claim s so u n d ing in tort ar e notfound onl yi n comm on- law deci s i ons . I n 1976, t he Penns y l vani a l egi s l atur e pas s ed the M ent al H eal t h Pr ocedur es A ct( “M H PA ”)

. P. L

. 817, N o. 143 ( 1976)

. T he r el evantpor t i on reads: In the ab sence o f w i l l fu l m iscond uct orgross negl i gence , a countyadmi ni s t r at or , a di r ect orof a fac i l i t y , a phy s i ci an, a peace offi ceroranyother author i zed pe r s on w ho part i ci pat es i n a dec i s i on th a t a p e rso n b e e x a m in e d o r tr e a te d u n d e r th is act , ort hata p erso n be di s char ged, orpl ace d underparti al hos pi t al i zat i on, outpat i entcar e or l eave of abs ence , ort hatt he r es t r ai n t u pon s uch p e rso n b e o th e rw ise re d u c e d , o r a c o u n ty admi ni s t r at o r orotherauthor i zed pe r s on w ho deni es an appl i cat i on forvol unt ary tr eatm entor fori nvol unt aryemer genc yexami nat i on and tre a tm e n t, sh a ll n o t b e c iv ill y o r c rim in a llyliab le for such d eci si on or for anyof it s conseq uen ces. 5 0 P a. C o n s. S tat

. § 7 1 1 4 (a). T a k i n g t h e c o n v e r s e o f t h e s t a tu t o r y l a n g u a g e , t he P e n n sy lv a n ia S u p re m e C o u rt h a s f o u n d a n a f

f irm a tiv e d u ty exis ts requ i ri ng t hat m ental health inst i tuti on s avoid gross negl i gence or w i l l ful m i s conduct i n t he t r eatm ent o f m ent al h e a lth p a tie n ts

. Sh e rk v . D a u p h in , 614 A

. 2d 226, 232 ( Pa. 1 9 9 2 ). I n th e la n d m a r k c a s e o n th e M H P A , G or yeb v

. P enn sylvan i a D epa rtm ent of P ub l i c W

el f are , 575 A

. 2d 545 ( Pa.23 1 9 9 0 ), the P en n sy lvan ia S u p rem e C o u rt h eld th at the a c t’ s l a n g u a g e , w h i c h l i m i t s l i a b i l i t y, a l s o e x p r e s s l y c r e a t e s a d u t y: W hen a Com m onw eal t h par t ypar t i ci pat es i n a deci s i on t hata per s on be exa m ined, t r eat ed or d isc h a rg e d p u rsu a n t to th e M e n tal H e a lth Pr ocedur es A ct , s uch a par t y s hal l notbe ci vi l l yor c rim in a llyliab le f

o r su c h d e c isio n o r f

o r a n yo f its cons equenc es exce pti n th e case of w i l l ful m i s conductorgr os s negl i gence . C onver s el y , and m o s t im p o rt a n tly to th e in s ta n t c a s e , a C om m onw eal t h par t ypar t i ci pat i ng i n a dec i s i on to e x a m in e , trea t o r d isc h a rg e a m e n tallyill p a tien t w ith in th e p u rv iew o f th e M e n tal H e a lth Pr ocedur es A ct w ho comm i t s w i l l ful m i s conduct orgr os s negl i gence can be l i abl e fors uch deci s i on. I d. at 54 8 -49 (em p h asis ad d ed ). T he Su p r e me Cou r t f

u r t h e r e x p l i c a t e d t h e s c o p e of t he dut ycr eat ed byt he M H PA

. T he l anguage i n t he M H PA s t at es t h a t n o l i a b i l i t y wi l l b e i mpo s e d f o r t h e d e c i s i o n i t s e l f “orfor an yo f it s co n seq u en ce s. ” 5 0 P a. C o n s. S tat

. § 7 1 1 4 (a). “C l ear l y , t he w or ds ‘ anyof i t s cons equenc es ’ ind ic at e the leg isla tiv e re c o g n iti o n th a t d isc h a rg in g a se v e re ly m e n tally di s abl ed per s on . . . i s a pot ent i al s er i ous dangernotonl yt o the pat i enthi m s el f butt o ‘ other s . ’ ” G or yeb , 5 7 5 A

. 2d at549. T her efor e, w heneve ra pl ai nt i ff can prove t hat t he hospi t al fai l ed t o m eetit s dut yt o r efr ai n fr om gr os s negl i gence i n deci s i ons r egar di ng t r eatm ent , di s char ge or com m i t m ent of a pat i ent , t he h o sp it al i s lia b le f

o r i n jury“‘to the p erso n o r pro p ertyo f th ir dT he courtul t i m at el yfound that t he G ui dance C ent erhad 8 n o t beh av ed in a g ross lyn eg li g en t m an n er. U ndert he FT C A , the fe der al governm entcan onl ybe 9 hel d l i abl e for br eac hes of dut i es i m pos ed on pr i vat e, r athert han s ta te , p a rt ie s . U

ni t ed Stat es v. O l

s on , 546 U

. S. 43, 43 ( 2005) ( hol di ng t hatthe fe der al governm entcannotbe hel d l i abl e for v i ol at i ng dut i es t hatar e i m pos ed so lely on st at e go vernm e n ts act i ng i n t hei rpecul i arpos i t i ons as governm ent s )

. I n t hi s cas e, 24 par t i es w her e s uch i nj u r yr es ul t ed fr om a hos pi t al ’ s negl i gent fai l ur e t o m eeti t s r es ponsibi l i t y . ’ ” I d. ( quot i ng V

at t i m o v. Low erB ucks H

os p. , I nc. , 4 6 5 A .2 d 1 2 3 1 , 1 2 4 0 (P a . 1 9 8 3 )); s ee als o Sherk , 614 A

. 2d at232. B as ed on G or

yeb and Sh erk , the S u p e rio r C o u rt in Ferrara found t hatt her e w as a dutycr eat ed bythe M ent al H ea lth an d M en tal R etard ati o n A ct, an ac t si m il ar in stru cture a n d p u rp o s e to th e M H P A

. Ferrara , 804 A

. 2d at1233. T he cour thel d t hatt he G ui dance C ent er , a non- pr ofi tor gani za t i on t h at pr ovi ded onl ygui dance t o t he r es i dent s of G r oup H om e, h a d a d u ty to re f

ra in f ro m g ro s s n e g lig e n c e . I d. at1233. 8 T her efor e, i f LZ

- I I i s a fac i l i t y cover ed by t he M H PA , t hen the V A had a dutyt o r efr ai n fr om gr os s negl i gence i n i t s t r eatm ent and dis charge d eci si on s r egardi ng D eJesus. 1. T h e f irst q u e stio n th a t p re se n ts itse lf u n d e r th e M H P A is w h e th e r O u tzs -C lev e lan d a n d th e o th e r V A p a rties in v o lv e d in De J e s u s ’ s r e l e a s e f

r o m L Z

- I I a r e s u b

j e c t t o t h e M HP A. T h e VA ar gues t hat , i n t hi s i ns t ance , theyw er e not

. T he M H PA appl i es 9t he V A has conce ded thatthe M H P A appl i es t o i teven i f the M H P A is w ritten so a s to a p p lyo n lyto g o v e rn m e n tal e n tit ies in Penns y l vani a. I f ther e i s a dutyi n thes e ci r cumst ance s undert he M HP A, t h e VA a g r e e s t h a t t h e d u t y a p p l i e s t o i t

. T h e r e f o r e , we d o n o t en g a g e in a n a n a ly sis o f w h e th e r p ro v id in g m e n tal h e a lth a ss ista n c e a n d c o m m itt in g p a tien ts is a d u ty th a t is p e c u liar to Penns y l vani a s t at e ment al heal t h fa ci l i t i es as governm ent al enti t i es. Di s c h a r g e i s n o td e f i n e d u n d e rth e M HP A. 10 25 t o phy s i ci ans or ot herauthor i zed pe r s ons w ho “part i ci pat e i n” a deci s i on t o t r eat or exami ne a per s on under t he act , ora dec i s i on re g a rd in g d isc h a rg e . 5 0 P a . C o n s. S tat. § 7 1 1 4 . “T re a tm e n t” 10 i s defi ned as “di agnos i s , eval uat i on, ther apy , orr ehabi l i t at i on neede d to al l evi at e pai n and di s t r es s and t o fac i l i t at e the r ecove r yof a per s on fr om m ent al i l l nes s and s hal l al s o i ncl ude car e and others ervi ces t hats u p p lem en tt r eatm entand ai d or p ro m o te s u c h re c o v e ry .” 5 0 P a . C o n s . S ta t. § 7 1 0 4 . It i s u n c o n tra v e rte d th a t O u tzs -C lev e lan d tre a ted D e J e s u s . A s h is pr i m ary t her api s t , O ut zs - C l evel and under t ook t her apys es s i ons w ith D e Je su s, p ro v id e d h im su p p o rt, an d h e lp e d h im d e a l w ith his subst ance a bu se probl em s. F u rth er, b o th O u tzs-C leve land an d D r. C h am b ers p arti cipa ted in the d e c is io n to d isch arg e D eJe su s fro m L Z -II

. W h i l e t h e VA h a s a r g u e d t h a t i t was LZ- I I , n o t t h e V A , t hat u ltim a te lyd ec ided to d isch arg e D eJe su s, the D istri ct C o u rt f o u n d th a t th e V A a n d its e m p lo y e e s w e re k e yp layers in a ll deci s i ons L Z

- I I m ade r eg ardi ng D eJ es us , part i cul ar l yi n t he d e c isio n to r e le a s e D e Je su s f ro m L Z -II. W e c a n re v e rse th is26 d e te rm i n a tio n o n ly if

it is c le a rl ye rr o n e o u s . Mi l l erv. P hi l a. G eri atr i c C tr. , 463 F. 3d 266, 270 ( 3d C i r . 2006)

. B as ed on the fac tt hatL Z

- I I cons ul t ed the V A s t aff ext ens i vel ybefor e maki ng a d e c isio n to re lea se D e Je su s a n d th a t th e V A p r o v id e d a ll m ent al h ea lt h car e t o L Z

- I I r es i dent s , w e fi nd t hatt he D i s t r i ct C o u rtd id n o t err in it s d eterm ination that the V A , an d n o t L Z -II , w as pri m ari l yres po nsi ble for the d eci si on t o rel ease D eJesus. H ow ever , det erm i ni ng t hatthe V A pr ovi ded phy s i ci ans and otherauthor i zed pe r s ons w ho part i ci pat ed i n deci sions re g a rd in g D e Je su s’s u lti m a te d isc h a rg e d o e s n o t b rin g it w ith in th e M H P A

. R at her, t he V A i s onlyl i able und er the d u ty i m pos ed byt he M H PA i f D eJe su s w as a pat i entatan ap p rop ri ate f

ac il ity . T h e M H P A a p p li es to “inv o lun tary t r e a t me n t o f me n t a l l y i l l p e r s o n s , whe t h e r i n p a t i e nt or o u tp a tien t, an d f

o r a ll v o lu n tar y in p a tien t tre a tm e n t o f m e n tally ill p e rso n s.” 5 0 P a . C o n s . S ta t. § 7 1 0 3 . P e n n sy lv a n ia c o u rts have hel d t hat t he M H PA does notappl yt o vol unt aryoutpat i ent tr e a tm e n t. E m er i ch , 7 2 0 A .2 d a t 1 0 3 8 n .7 ; s e e als o C ha rt i ers C om m
. Me n ta lHea l th & Re ta r da t i o n Ce n t e r, I n c
. v
. Dep t

. of P ub

. W el f are , 6 9 6 A

. 2 d 2 4 4 , 2 4 7 -48 (P a. C o m m w . C t. 1 9 9 7 ). Pr i or t o t r i al , bot h par t i es s t i pul at ed t o t he fa ctt hat , w hen he w as at L Z

- I I , D eJ es us w as r ece i vi ng out pat i ent tr eatm ent fro m the V A

. H o w ev er, th at s tip u la tio n is no t dispo sit ive. In th e c a se b e f

o re u s, w e a r e n o t ex a m in in g th e V A ’s d e c isio n to di s char ge D eJ es us fr om t he vol unt ary , outpat i entt r eatm enthe wa s r e c e i v i n g f

r o m O u t z s - Cl e v e l a n d a n d o t h e r s a tth e VA. R athe r, w e a re e x am inin g th e V A ’s de cisi o n to h av e L Z -II r el eas e D eJ es us fr om t he comm uni t yi n w hi ch he ha d been l i vi ng forover a y ea r. N othi ng i n t he M H PA r equi r es thatthe phy s i ci an orot herautho ri zed pe r s on actual l yw or k fort heT he V A agre ed t o br oad cons t ruct i on i n i t s openi ng 11 b rie f su b m itt e d to th is C o u rt. “ [ T ]h is pr o tec tio n g ra n ted to m e n ta l h e a lth w o rk e rs is to b e c o n s tru e d b ro a d ly . . . .” 27 i npat i entfac i l i t yw her e t he pat i ent i s l ocat ed. R ather , i tr equi r es t hata phy s i ci an or author i zed per s on “part i ci pat es i n” a de ci s i on t o t r eat ordi s char ge the pat i ent

. T her efor e, i f D eJ es us w as an i npat i entatL Z

- I I , and t he V A par t i ci pat ed i n a dec i s i on t o tr eat ordi sch arg e h im, i tm ays t i l l be l i abl e undert he M H PA for i m pr oper l ys uggesti n g t hatL Z

- I I di s char ge D eJ es us and then f a i l i n g t o c o mmi th i m. W h ethe r a c o m m u n ityli v ing fa cil ityli k e L Z -II c on s t i tut e s a fa c i l i t ytha tpr ov i de s i np a t i e ntt r e a t m ent i s a q u e stio n o f f

irst i m p re ss io n f

o r th is C o u rt a n d th e P e n n sy lv a n ia cour t s . A s in al l cas es t hatdepend on s t atut oryi nt erpr et at i on, we b e g i n wi t h t h e l a n g u a g e o f th e s t a tu t e . Un d e rth e M HP A: “Inpa t i entt r eatm ent ” s hal l i ncl ude al l tr eatm ent t hatr equi r es ful l orpart

- t i m e r es i dence i n a f a c i l i t y . F o rt h e p u rp o s e s o f th i s a c t , a “ f

a c i l i t y” m e a n s an y m e n tal h e a lth e sta b lish m e n t, ho sp ital, cl i nic, i nst i tuti on , center , d a ycare cent er, base s ervi ce uni t , comm uni t ym ent al heal t h cent er , or partt hereof, t hat pr ov i des fo r the d iag no si s, tre a tm e n t, ca re o r re h a b ili tatio n o f m e n tallyill persons, w hetheras i np at i ents or outpat i ents

. 50 Pa. C ons . St at

. § 7103. G e n e ra lly , the ter m s o f th e M H P A h a v e b e e n b ro a d ly cons t rued byPenns y l vani a cour t s . Forexampl e, i n A l l en v. 1128 Mon tgom er

y H os pi tal , 696 A

. 2d 1175 ( Pa. 1997) , t he P e n n sy lv a n ia S u p re m e C o u rt ru led th a t th e lim ited liab ili ty p ro v isio n o f

th e M H P A e x ten d e d to c a re g iv e n b ya p h y sic ian in a h o sp ital f

o r p h y sic a l ailm e n ts pla g u in g a m e n tallyill p a tien t.

“ [ T ]h e G e n e ra l A ss e m b lyd id n o t in ten d to lim it tre a tm e n t to t hato n l yd i r e c t l yr e l a t e d t o a p a t i e n t ’ s me n t a l i l l n e s s . I ns t ead, t r eatm enti s gi ven a br oade rm eani ng i n the M H PA t o i ncl ude m edi cal car e coi nci dentt o m ent al heal t h car e. ” I d. at307. T he br oad cons t ruct i on of the M H PA gui des our i nt erpr et at i on of the i npat i entr equi r ementand l eads us t o b eli eve thatthe P e n n sy lv a n ia S u p re m e C o u rt w o u ld f in d th a t, u n d e r th e sp e c if ic f a c ts o f th is c a se , L Z -II w a s p ro v id in g in p a tien t trea tm e n t to D eJesus. T he D i s t r i ctC our tfound the fol l ow i ng fac t s : L Z

- I I had rul es by w hi ch i t s r es i dent s m us t abi de t o cont i nue l i vi ng t her e; L Z -II re sid e n ts w e re p ro h ib ited f ro m h a v in g a lc o h o l in th e ir r oom s ; r es i dent s atL Z

- I I w er e r equi r ed t o s i gn i n and outof the f a c ili ty ; L Z -II o v e r s a w re sid e n ts’ f in a n c e s to e n su re re sid e n ts w e re b e in g f

isc a llyre sp o n sib le; L Z -II re se rv e d th e rig h t to conductr oom s ear ches atanyt im e and conduct ed ac tual s ear ches on a w eekl y bas i s ; as an LZ

- I I r es i dent , D eJ es us t ook p a rt in g ro u p th e ra p yse ss io n s a n d c o n tin u e d c o u n se lin g in s ubs t ance abus e; as an L Z

- I I r es i dent , D eJ es us had ar ound- t hecl o ck m ent al heal t h hel p avai l abl e t o hi m ; D eJ es us had con t i nu ed acc e ss to his pri m aryt herapi st

. B ased on t hese sp e c if ic f a c ts, w e c o n c lu d e th a t D e Je su s w a s a n in p a tien t w ith in t h e me a n i n g o f

t h e M HP A. D eJ es us w as nots i m pl yresi di ng i n an apa r t m ent s ubs i di zed byL Z

- I I

. R ather , he w as a re s i dent at a fa ci l i t yt hat c lo se lym o n ito re d n e a rlye v e rya sp e c t o f h is life : h is jo b , h is29 dai l y m ovement s , hi s fi nance s , and hi s m ent al w el l

- bei ng. E ven hi s abi l i t y t o r et ai n hi s pl ace of r es i dence r es t ed on hi s cont i nued w i l l i ngnes s t o abi de byrul es t hat lim it ed hi s fr eedom and inv o lved a su b stan ti al re d u cti o n in h is p erso n al priva cy . L Z -II , i n addi t i on t o pr ovi di ng D eJ es us w i t h a pl ace t o l i ve, pr ovi ded h im , thr o u g h its c o n tra c t w ith th e V A , w ith 2 4 -h o u r a c c e ss to m ent al heal t h car e, cont i nued i ndi vi dual and gr oup t her apy , and l es s ons i n t he l i fe s ki l l s nece s s aryfora r ecove r i ng s ubs t ance abus erw i t h a hi story o f m ent al i ns t abi l i t yt o t r ans i t i on t o l i fe out s i de t he contr ol l ed w al l s of L Z

- I I

. T he combi nat i on of t he r est ri ct i ons i m pos ed on D eJ es us and the s ervi ces pr ovi ded by L Z -I I m ake itan “inst i tuti on . . . t hat prov i des for the d i agn osi s, t r eatm ent , car e orr ehabi l i t at i on of m ent al l yi l l per s ons , w hether as outpat i ent s ori npat i ent s . ” 50 Pa. C ons . St at

. § 7103. E ven i f LZ

- I I c oul d notbe t erm ed an i ns t i tut i on t hat p ro v id e s t reatm ent of m ental l yi l l persons i n an d o f i t sel f, i tis s t i l l a qual i fy i ng fac i l i t yunderthe M H PA

. Sect i on 71 03 in c lu d e s in it s d e f

in iti o n o f

f a c ili ty“ a n ym e n tal h e a lth estab li sh m en t .

. . o r par tther eof ” th a t trea ts m e n ta llyill p e rs o n s . I

d. ( emphasi s added)

. W hi l e LZ

- I I i s a pr i vat el yrun g rou p h o m e, i ts l o ca ti o n , o rga n izati o n an d fu n d ing m ak e it“p art of” the V A C oat es vi l l e compound, w hi ch i s cl ear l y a qual i fy i ng f a c i l i t y . L Z

- I I o p e r a t e s p r i ma r i l y o n g r a n tmo n e yf r o m th e VA. I ti s l ocat ed on the V A C oat es vi l l e prope r t y i n a bui l di ng ow ned b yt h e VA

. I t h a s a c o n t r a c t w i th t h e V A i n w h i c h t h e VA pr ovi des m edi cal and ps y chi atr i c se rvice s as w el l as fi r e and p o l i c e p r o t e c t i o n . L Z

- I I c o n f e r e n c e s r e g u l a r l ywi t h VA couns el or s , ps y chol ogi s t s , and ps y chi atr i s t s r egar di ng t he tr ea tm en t of

L Z -I I reside n ts, an d the V A co m m o n lytr an sfe rs pati e nt s fr om i t s i np a t i e nt D omi c i l i a r y Pr og r a m t o LZ- I I as a30 w a yf o r t h o s e p a tie n ts to tr a n s itio n to lif e o u ts id e th e f

a c i l i t y. T hes e fa ct or s ar e s uff ic i entt o s how thatL Z

- I I w as notan i s ol at ed r es i dent i al fac i l i t y , butr athera partof an i nt egr at ed cam pu s desi gn ed to serve t he tot al health o f veter ans. T her efo re, a ta mi ni m um , L Z

- I I i s “partof” a fac i l i t yt hat p ro v id e s “ d iag n o sis , trea tm e n t, ca re o r rehabil i t at i o n o f m e n tally i l l per s ons , w hetheras i npat i ent s oroutpat i ent s . ” I d. Fur t her , w hi l e D eJ es us ’ s i nt er act i ons w i t h V A ther apy m a ytec h n ica llyb e ter m e d “ o u tp a tien t trea tm e n t,” v iew in g h is o v era l l t r eatm enti n combi nat i on w i t h hi s r es i dence atL Z

- II i ndi cat es he was r ece i vi ng vol unt ary , i npat i enttr eatm ent

. U nder t he M H P A , “‘ [i ] npat i entt r eatm ent ’ s hal l i ncl ude al l t r eatm ent t hat r equi r es ful l or par t

- t i m e r es i dence i n a fa ci l i t y . ” I d. W h ile D eJ es us coul d have c ont i nued t o cont actO u tz s - C l evel and had he l i ved anyw her e, i n or dert o r ece i ve ar ound- t he- cl ock ment al h e a lth a ss ista n c e , co n ti n u e d g ro u p th e ra p y , an d th e les so n s in l i fe s ki l l s , i n addi t i on t o hi s cont act w ith O ut zs - C l evel and, D eJ es us w as req ui r ed t o m ai nt ai n r es i dence atL Z

- I I

. T he r es t r i ct i ons pl ace d on D eJ es us byL Z -II , hi s cont i nued ther apy w ith V A p ro f

e ss io n a ls, a n d th e V A ’s in tim a te r e latio n sh ip w ith L Z

- I I , t aken i n t he aggreg ate, s at i s fyus thatD eJ es us w as r ece i ving inp at i entt r eatm entata qual i fy i ng fac i l i t yundert he M HP A. Be c a u s e , a s we h a v e i n d i c a t e d a b o v e , th e VA par t i ci pat ed i n a dec i s i on t o di s char ge D eJ es us fr om that i npat i entfac i l i t y , i thad a dutyt o r efr ai n fr om gr os s negl i gence i n thatdecis i on and i t s treatm ent of D eJesus. 2. H av ing det erm i ned thatthe V A had a dutyunderthe M H PA , w e mustnextcons i derw hetheri t s b eh avi orw as31 su ff ici en tl yn eg li g en t t o m ee t th e “ g ross n eg li g en ce ” stan d ard under t h e M HPA

. I n o r d e rt o r e c o v e rf r o m a n i n s t i tu t i on inv o lved in m en tal h ea lth d ec isi o n s, a plainti ff m u st pro v e m o re t han s i m pl e negl i gence . T he M H PA gr an ts i m m uni t yt o s uch i ns t i tuti on s unles s the p l ai nti ff can show w i l l ful cond uct orgross n eg li g en ce . 5 0 P a. C o n s. S tat

. § 7 1 1 4 (a). “It ap p ea rs th at the l eg isl ature inten d ed to req u ir e that li ab il ity b e p rem ised o n fa cts i n d icati n g m o re eg reg iou slyd ev iant co n d u ct th an o rdi n ary car el es s nes s , i n a d v e rt e nce, l axi t y , ori ndi ffe r ence . W e h o ld th a t the legislatu re inten d ed the term g ross negl i gence t o m ean aform of negl i gence w her e the fa ct s s uppor ts ubs t ant ial l ym or e than or di narycar el es s ness, i nadvert ence , l axi t y , or i nd i fference. T he b ehav i or of the defen dan tm ust b e f lagra n t, g ross lyd ev iat ing fro m the o rdin ary s ta n d a rd o f

c a re .” A l br ightv. A bbi ngt on Mem
. H os p. , 696 A

. 2d 1159, 11 6 4 (P a. 1997) ( quot i ng B l oo m v. D uB ois R eg’lMed. C tr. , 597 A

. 2d 671, 6 7 9 (P a . S u p e r. C t. 19 9 1 )); W al s h v. B or cz on , 881 A

. 2d 1, 7 ( Pa. S u p e r. C t. 20 0 5 ). W h ile th e b e h a v io r m u st b e m o re th a n sim p le n e g lig e n c e , itn e e d n o t re a c h th e lev e l o f w a n to n c o n d u c t. “N egl i gence cons i s t s of i nat t ent i on ori nadvertence , w her eas w ant onnes s exi s t s w her e the da n g er t o t he pl ai nt i ff, t hough r eal i zed, i s s o r eckl es s l y di s r egar ded t hat , even though t her e be n o a c tu a l in te n t, th e re is a t le a s t a w illin g n e s s to in f lic t in ju ry, a c o n s c io u s in d if

f e re n c e to th e p e r p e tr a tio n o f th e w ro n g .” B l oom , 5 9 7 A .2 d a t 6 7 9 . G ro ss n e g lig e n c e lies so m e w h e re in betw een.32 I n i t s very t hor ough deci s i on, t he D i s t r i ctC our trul ed that t he V A w as g ros s l ynegl i genti n a numberof w ay s . Fi r s t , t he Di s t r i c tCo u r t f

o u n d t h a tth e f

a i l u r e o f a n yme mb e ro f

th e VA s t aff t o be ful l yfami l i arw i t h D eJ es us ’ s m edi cal condi t i on w as a “gr os s devi at i on fr om t he r equi r ed s t andar d of ca r e i n t r eat i ng a p ati en t. ” F u rth er, th e D istri ct C o u rtruled that the V A ’s deci s i on t o di s char ge D eJ es us w hen he “ w as di s t r es s ed and i r r at i onal , di s pl ay i ng poorcontr ol o f h is vi ol entur ges by br andi s hi ng a kni fe i n hi s pl ace of empl oym ent ” an d m aki ng c o m m e n ts “th a t h is P rim a ry T h e ra p ist b e liev e d w e re p o ten tially s ui ci dal ” al s o cons t i tut ed a gr os s br eac h of the s t andar d of ca r e. F in a ll y , the D istric t C o u rt ru led th a t th e V A w a s n e g lig e n t in f a ili n g to c o m m it o r d e tain D e Je su s f o r a p sy c h iatric cons ul t at i on once he had bee n di s char ged fr om L Z

- I I

. G i ven D eJ es us ’ s behavi or on M ar ch 22, t he D i s t r i ct C our ts t at ed that t her e w as s uffi ci ent evi dence t o have D eJ es us comm i t t ed under P enn sy l van i a l aw or t he V A ’s i nternal com m i t m ent pr oced ures, w hi ch r equi r e a “ cl earand pr es entdangerto [th e p at i ent ] or o t h e r s . ” Ho we v e r , a s t h e VA s t a f f wa s u n c l e a ra b o u ti t s o wn c o m m itm e n t p ro c e d u re s a n d f a iled to c o n d u c t an a p p ro p ria te su icid e o r p sy c h iatric a ss e ss m e n t, i ts c o n d u c t w a s g ro ss ly negl i gent

. W e r evi ew t he D i s t r i ct C our t ’ s det erm i nat i on t hatt he V A a c te d in a g ro s s ly n e g lig e n t m a n n e r f o r c l e a r e rr o r. See R odr i quezv. U

ni t ed Stat es , 8 2 3 F

. 2 d 7 3 5 , 7 4 2 (3d C ir

. 1 9 8 7 ). T he Penns y l vani a ca s es fi ndi ng onl ys i m pl e negl i gence i nvol ve si gni fi cant l y l es s egr egi ous br eac hes of t he s t andar d of ca re th an that ex h ibit ed h ere an d o ften lack su ff ici en t exp ert tes tim o n yto p ro v e th e p lain tiff ’s c a se . F o r e x a m p le, in A l br ight , aft ert he pl ai nt i ff’ s w i fe mi ssed an appoi nt m ent , and w i t h onl yfourday s r emai ni ng i n a 90- day i nvol unt aryoutpat i ent33 t reatm ent pr og ram , t he p l ai nti ff co ntact ed the ho spi t al becau se hi s w i fe w as nott aki ng herm edi cat i on, s eemed t o be s uffe r i ng fr om a m ani c epi s ode, w as chai n s m oki ng and had l efta tur key t o bur n i n t he oven. T he hos pi t al r es ponded bys ett i ng up an appoi nt m entw i th the pl ai nt i ff’ s w i fe a ft ert he hol i day s and encour agi ng t he pl ai nt i ff t o br i ng hert o the hos pi t al for i nvol unt arycomm i t m ent , a su g ges t i on t he pl ai nt i ff i gnor ed. Soon t her eaf

t er , t he pl ai nt i ff’ s w i fe w as s m oki ng car el es s l yand bur ned dow n t hei rhous e, t aki ng herow n l i fe w it h i t

. T he Penns y l vani a Supr eme C our tfound thi s w as i ns uffi ci entt o fi nd g ro s s n e g lig e n c e . A l br ight , 696 A

. 2d at1165- 66. W hi l e the hos pi t al ’ s fai l ur e t o fol l ow - up w hen the pl ai nt i ff’ s w i fe mi s s ed a n a p p o in tm e n t m a y h a v e b e e n a n e x e rc is e o f p o o r j u d g m e n t, i d. at 1167, t he hospi t al di d t ake some aff i r m at i ve st eps t o r epai rt he err orbys chedul i ng an appoi n tm en t a nd encour agi ng the p la in tif f to h a v e h is w if

e c o m m itte d

. I

d. at 11 66

. “T he p urpose o f th e [ M H P A ’s] i m m u n ityp ro v isio n is to in su late m e n tal h e a lth em p lo y e es a n d their em p loy ers f rom li ab il ityfo r th e v ery det erm i nat i on m ade bythe H os pi t al her e. ” I d. at1167. U nl i ke A l br ight , t he D i s t r i ct C ourt found t hat t he V A had m or e s er i ous w arni ng s i gns r egar di ng D eJ es us ’ s condi t i on t han s i m pl yl eavi ng a tur keybur ni ng i n t he oven. Fur t her , no one on t he V A ’ s s t aff

w as fami l i arw i t h D eJ es us ’ s m edi cal hi s t ory , no one s chedul ed anyki nd o f an appoi nt m entaft erhe ca l l ed di s t r aughtoverhi s pendi ng di vor ce, and ther e w as i ns uffi ci ent comm uni cat i on betw een mem ber s of the V A s t aff

. F u rth er, C am il le an d F au lk p res e n ted d etail ed ex p ert t es t i m onybyD r . G ol ds t ei n indi cat i ng thatthe V A ’ s behavi or g ross lyd ev iat ed fro m the a p p rop ri a te s ta n d ard o f c are . D r. G o ld ste in tes tifie d th a t “th e a c t o f d isc h a rg in g [ D e Je su s] w o u ld34 . . . t ake s om eone w ho’ s al r eady i n cr i s i s and .

. . compound t he cr i s i s m anyfol d .

. . . It ’s v ery ine xpl i cabl e. ” H e furt her t es t i fi ed as t o fi ve s peci fi c br eac hes and cha r act er i zed them as “extr eme and egr egi ous ”:

W ell , I’d h av e to s aytheyw ere v ery ext reme and egr egi ous , r eal l y , beca us e mul t i pl e, mu l t i p l e b r e a c h e s , b r e a k d o wn s i n t h e s y s t e m, m ul t i pl e devi at i ons , departur es fr om t he ac cept ed s t andar d of ca r e. A nd i n ad di t i on, i tw as the fac t orof the di m ens i on of i t bei ng know n t hatthe – i n other w or ds , the per s on w i t h the cl i ni cal r es pons i bi l i t y , [O ut zs - C l evel and] , r ecogni zed the risk , ex p lain e d w h yth e re w a s a risk , v e ryw e ll document ed not es , and t hen pr ocee ded t o do n o th in g a b o u t it

. [I ] n ot herw or d s, s he r ecogni zed the danger , and di dn’ t t ake appr opr i at e s t eps , m aybe beca us e s he di dn’ t know how t o t ake them. So I w oul d s ayi tw as a maj or , m aj orbr eakdow n. In its f in d in g s o f f

a c t, th e D istric t C o u rt e x p licitlysta ted th a t it g a v e g re a t cr e d e n c e to D r. G o ld ste in ’s te stim o n y , a c re d ib ili ty d eterm ination to w h ich w e g ive c o n side rab le de fe ren ce . D r. G o ld s te in ’ s te s ti m o n y, u n li k e th e te s ti m o n y in c a s e s f in d in g o n ly sim p le n e g lig e n c e , u n e q u iv o c a llysta ted th a t th e b re a c h o f d u ty in this ca se w en t bey o n d m ere ca relessn ess o r i n ad v erten ce . It w a s w h a t D r. G o ld s te in c a l le d “ a m a jo r, m a jo r b re a k d o w n .” See , e. g. , W

als h , 881 A

. 2d at 8 ( hol di ng t hatt her e w as in su f f icie n t ev id e n c e o f

g ro ss n e g lig e n c e w h e re e x p e rt o n ly t es t i f i e d t h a t c l i n i c ’ s f

a i l u r e t o f

o l l o w- u p wi t h p a t i e n t w as35 “m ism an ag em en t” an d “u n d er-ap p rec iat ion ” o f p lai n ti ff ’s c o n d iti o n ); D ow ney v. C rozer- C hest er Med. C tr. , 817 A

. 2d 517, 26 ( Pa. Super

. C t. 2 003) ( hol di ng thatexpert ’ s t es t i m onyw as insu ff ici en t t o estab li sh g ro s s n eg li g en ce w h ere ex p ert c h a ra c te r iz e d h o sp ital’s f a ilu re to su p e rv ise p a tien t w h ile b athin g o n lyas a d ev iat ion fro m the s tand ard o f c are ). T hi s cas e cl os el yacc or ds w i t h a dec i s i on of the C our tof C om m on Pl eas of Penns y l vani a, Phi l adel phi a C o u nty , w hi ch, w hi l e i n no w aybi ndi ng, i s i ns t ruct i ve. I n Me rtz v . T e m p le U ni ver sit y Hos pi tal , 2 5 P a . D . & C . 4 th 5 4 1 (P a . C o m m . P l. 199 5) , t he courtfound s uffi ci entevi dence of gr os s negl i gence w her e a hos pi t al fai l ed t o comm i ta pat i entaft erhe exhi bi t ed s ig n s o f s u ic id e . I

d. at 557- 58. T he psy chi atr i s t on dutyfai l ed t o do anyt hi ng m or e than r evi ew the pat i ent ’ s chartbefo re r el eas i ng hi m . T he courtru led tha tt he hos pi t al s houl d have sp en t m o re ti m e w ith the p lai n ti ff an d h is m ed ical reco rds b ef o re r el eas ing hi m , r es ul t i ng i n t he hos pi t al ’ s l i abi l i t yfordamages re s u l t i n g f

ro m h is s u b s e q u e n t s u ic id e . I d. a t 5 5 8 ; see al

so B l oom , 597 A

. 2d at 679 ( s uffi ci entevi dence of gr os s negl i gence to w ith sta n d su m m a ry ju d g m e n t w h e re p a tien t w a s a d m itt e d to t he ps y chi atr i c uni t , w as notdi agnos ed or tr eat ed, and w as l at er fo u n d h an g ing b yh er sh o elac es in a b athro o m in the u n it ). In f a c t-in ten siv e in q u iries su c h a s th e se , d u e d e f e re n c e is o w e d to th e D istric t C o u rt’s d e ter m in a tio n . B a s e d o n its ext ens i ve fa ctual fi ndi ngs and appl i cat i on of t he fa ct s t o t he l aw o f g ross n eg li g en ce , w e a re sa ti sfi ed that the D istri ct C o u rt ’s det erm i nat i on t hatt he V A w as gr os s l y negl i gent i s notonl ynot cl ear l yerr oneous , buti s a corr ectdeci s i on.36 V I. I n s um m ary , beca us e D eJ es us di d not m ake a t h rea t of im m ed iat e h arm ag ains t a read il yiden ti fiab le victi m , C am il le’s and F aul k’ s fai l ur e- t o- w arn cl ai m s w er e pr oper l ydi s m i s s ed. H ow ever , t he V A w as undera s t atut orydutyt o r efr ai n fr om gr os s negl i gence i n i t s t r eatm entof D eJ es us , and t he D i s t r i ct C our tdi d noterri n i t s det erm i nat i on thatt he V A act ed i n s uch a g ross lyn eg li g en t m an n er w h en itstr o n g ly e n co u rag ed L Z -II to d isc h a rg e D e Je su s a n d th e n f a iled to c o m m it h im u n d e r its pr ocedur es orPenns y l vania’s M H P A

. T h ese eg reg iou s b rea ch es of the appr opr i at e s t andar d of car e re s ul t ed i n the tr agi c s hoot i ng deaths of four chi l dr en and D eJ es us ’ s ow n s ui ci de. T her efor e, and fort he r eas ons ful l ys t at ed above , w e w il l a ffi r m the ju d g m e n t o f

th e D istric t C o u rt.