Opinion ID: 2628954
Heading Depth: 1
Heading Rank: 8

Heading: Boulanger

Text: This holding was disapproved in part, however, in the next case to consider the relationship between a psychiatrist and those who were injured by a psychiatric patient. In Boulanger v. Pol, 258 Kan. 289, 900 P.2d 823 (1995), a patient shot his uncle shortly after his release from an intermediate care facility where he had been a voluntary patient. Relying on Durflinger, the plaintiff argued a duty arose from the physician-patient relationship and no additional basis had to be established. The Boulanger court disagreed, recognizing that a physician-patient relationship creates a duty owed to the patient only, not to those outside that relationship. 258 Kan. at 297-98, 900 P.2d 823. In addition, the Boulanger court limited Durflinger's discussion of duty to cases involving involuntary commitments, stating: We conclude that the duty recognized in Durflinger was based upon the statutory provisions applicable to the commitment and release of involuntary patients and is not applicable to voluntary patients. The cause of action for negligent release of an involuntary patient recognized in Durflinger does not apply to voluntary patients. Boulanger, 258 Kan. at 303, 900 P.2d 823. In reaching this decision, the Boulanger court discussed two intervening federal decisions Hokansen v. United States, 868 F.2d 372 (10th Cir.1989), and Mahomes-Vinson v. United States, 751 F.Supp. 913 (D.Kan. 1990),the latter of which is relied on by the Plaintiffs in this case. In Hokansen, the plaintiffs, who were appealing a federal district court decision that Durflinger applied only to involuntarily committed patients, argued that Durflinger should apply to voluntary as well as involuntary patients. The Tenth Circuit Court of Appeals rejected the argument and, in affirming the federal district court, noted that a patient may only be involuntarily committed if found to be mentally ill, which means the person must be a danger to self or others. Observing [t]hat is the critical distinction, the Tenth Circuit concluded that the Durflinger court had found a duty to the public arising from the determination that the hospital professionals are required to make under the involuntary commitment statutes that the patient is no longer a danger to self or others. In contrast, [n]o such determination was required under the Kansas statutes when the hospital released [the patient] from treatment as a voluntary inpatient. Hokansen, 868 F.2d at 376-77. The Tenth Circuit in Hokansen also noted: A voluntary patient may request discharge, and a hospital is then required to release the patient within the next three days.... [K.S.A.] 59-2907 [repealed L.1996, ch. 167, sec. 65; now K.S.A. 59-2951], however, does not impose any duty upon the hospital to seek commitment. It does not even suggest any criteria by which a hospital should decide whether or not to seek commitment. In any event, the statutory language at no point suggests any obligation by the hospital to third parties to exercise the power to seek commitment. Hokansen, 868 F.2d at 376-77 n. 7. After citing and quoting from the decision in Hokansen, the Boulanger court considered the federal district court decision that is relied on by Katherine and Alexandra, Mahomes-Vinson, 751 F.Supp. 913, in making their argument that a duty arose under Restatement § 315. The case does not support their statutory duty argument, however. Mahomes-Vinson arose after a voluntary patient, who had a long history of sexual and physical violence, was discharged from a veterans' hospital and 8 days later raped, sodomized, and killed two young girls. The plaintiff in Mahomes-Vinson acknowledged the holding in Hokansen but argued an amendment to the statute allowed for a different result. The amendment, adopted in 1986, provided: Nothing in this act shall prevent the head of a treatment facility or other person from filing an application for determination of mental illness with respect to a voluntary patient who is refusing reasonable treatment efforts and is likely to cause harm to self or others if discharged. K.S.A. 1986 Supp. 59-2907 (repealed L.1996, ch. 167, sec. 65) (Currently, K.S.A. 59-2952 provides that the head of a treatment facility  may file a petition ... seeking involuntary commitment of a voluntary patient who now lacks capacity to make an informed decision concerning treatment and who is refusing reasonable treatment efforts or has requested discharge from the treatment facility. [Emphasis added.]) The plaintiff argued the Kansas Legislature created a duty that did not exist in Hokansen by amending the statute in 1986 to indicate the head of the treatment facility could seek a commitment. The federal district court disagreed, stating the Kansas legislature in 1986 did not impose a duty on the defendant to apply for a determination of mental illness. Mahomes-Vinson, 751 F.Supp. at 919. The court distinguished between having a mechanism available and having a duty that required use of the mechanism. Quoting this discussion, the Boulanger court noted the 1986 amendment also applied in its case, and it also rejected the existence of a duty under the provision. 258 Kan. at 302-03, 900 P.2d 823. In Boulanger, the patientlike Adamhad been hospitalized on several occasions. At least one hospitalization arose after the patient assaulted his father and attempted to stab himself. Although the patient's last hospitalization was voluntary, the head of the hospital evaluated whether the discharge should occur and allowed the discharge because he did not believe the patient was dangerous to himself or others as long as he took his medication and was in a structured setting. The patient was transferred to an intermediate care facility where his daily medication was monitored and he was observed for evidence of continuing homicidal or suicidal ideation. After a period of time, he was discharged to his parent's care. Ten days later he shot his uncle. Under those circumstances, the court agreed with the holding in Mahomes-Vinson that, even if the propensity for danger existed, the existence of a mechanism for seeking commitment did not create a duty to have the patient committed. Thus, the court concluded no statutory duty was owed to the uncle. Boulanger, 258 Kan. at 303, 900 P.2d 823. The Boulanger court then focused on the uncle's argument that the defendants owed him a duty under the special relationship doctrine set forth in Restatement § 315, which provides: There is no duty so to control the conduct of a third person as to prevent him from causing physical harm to another unless (a) a special relation exists between the actor and the third person which imposes a duty upon the actor to control the third person's conduct, or (b) a special relation exists between the actor and the other which gives to the other a right to protection. Citing to C.J.W. v. State, 253 Kan. 1, 7-8, 853 P.2d 4 (1993), the Boulanger court recognized several ways for a special relationship to exist: A duty to control arises because of the relationship between a parent and child (Restatement § 316), master and servant (Restatement § 317), persons in charge of one with dangerous propensities (Restatement § 319), and persons with custody of another (Restatement § 320). Boulanger, 258 Kan. at 303, 900 P.2d 823; see Restatement § 315, Comment c (special relations between the actor and the third person which require the actor to control the third person's conduct are stated in §§ 316-319; those which arise because of a relationship between the actor and another that require the actor to control the conduct of third persons for the protection of the other are stated in §§ 314A and 320). The plaintiff in Boulanger, like the plaintiffs in Mahomes-Vinson and in this case, relied on Restatement § 319. That section provides: One who takes charge of a third person whom he knows or should know to be likely to cause bodily harms to others if not controlled is under a duty to exercise reasonable care to control the third person to prevent him from doing such harm. The Boulanger court noted that the federal district court in Mahomes-Vinson and several courts in other jurisdictions had recognized a duty based on Restatement §§ 315 and 319 requiring a mental health care provider to take some affirmative action to protect a foreseeable victim of the patient, such as notifying the potential victim, calling the police, or instituting commitment proceedings. The Boulanger court rejected that view under the facts of the case before it, however. The court noted the patient's uncle knew of the patient's dangerous propensities and that the patient considered the uncle to be the devil incarnate. See 258 Kan. at 290-92, 307-08, 900 P.2d 823. Because of this knowledge, the court concluded there was no duty to warn. Boulanger, 258 Kan. at 307, 900 P.2d 823. Additionally, the Boulanger court concluded the doctors did not have a duty to seek the involuntary commitment of the patient and concluded that defendants did not have the requisite control of [the patient] which might conceivably create a duty under § 319. Boulanger, 258 Kan. at 308, 900 P.2d 823. Thus, the Boulanger court concluded there was no special relationship imposing a duty under the Restatement or under Kansas statutes. 258 Kan. at 308, 900 P.2d 823.