Opinion ID: 624999
Heading Depth: 3
Heading Rank: 3

Heading: Dr. Houghton

Text: When Dr. Houghton met with Ghane on February 5, 2003, the day after Ghane's admission to OPRMC, Ghane threatened unnamed government employees in the Corps of Engineers and noted that he had access to chemicals. Ghane made these statements to Dr. Houghton in a highly charged emotional state; Ghane's demeanor that day was different, more irritated and hostile, than it had been on all of Dr. Houghton's multiple, previous encounters with Ghane. As a result of this perceived threat, Dr. Houghton sought the advice from the hospital's risk management and ultimately obtained Ghane's consent to notify appropriate legal authorities of the threats. Both parties astutely agree that the statements made by Ghane to Dr. Houghton fall directly within the psychotherapist-patient privilege previously discussed. Dr. Houghton was Ghane's treating psychiatrist and Ghane's statements were made to Dr. Houghton in the course of treatment. However, the district court applied, and Ghane now challenges, an exception to this privilege recognized by a discrete number of circuits; that is, the dangerous patient exception. Accordingly, Dr. Houghton testified at Ghane's criminal trial. In Jaffee, the Court observed in a footnote: [W]e do not doubt that there are situations in which the privilege must give way, for example, if a serious threat of harm to the patient or to others can be averted only by means of a disclosure by the therapist. Jaffee, 518 U.S. at 18 n. 19, 116 S.Ct. 1923. Arising from this dictum is a dangerous patient exception to the psychotherapist-patient privilege discussed, but often rejected, by circuit courts. United States v. Auster, 517 F.3d 312, 315-16 (5th Cir.2008) (recognizing that an exception to the privilege exists and can be useful in a criminal trial, but refusing to apply it on the facts of the case because the patient knew his communication to his therapist was not confidential); United States v. Chase, 340 F.3d 978, 992 (9th Cir.2003) (en banc) (holding that even if a patient knows that a threat is not made in confidence, any statements made to the therapist are privileged in a federal trial); Hayes, 227 F.3d at 583-87 (analyzing and ultimately rejecting the dangerous patient exception to the federal psychotherapist-patient testimonial privilege); United States v. Glass, 133 F.3d 1356, 1360 (10th Cir.1998) (restricting the application of the exception to situations where the threat was serious when it was uttered and its disclosure was the only means of averting harm). Ghane argues that the dangerous patient exception has no place in federal criminal law, citing the reasoning of the Sixth and Ninth circuits, which have rejected its application. We agree with our sister circuits that have rejected this exception and decline to interpret the dictum in Jaffee as establishing a precedentially binding dangerous patient exception to the federal psychotherapist-patient testimonial privilege. In Hayes, the Sixth Circuit adeptly analyzed the dangers associated with the adoption of such an exception. We adopt Hayes' reasoning. At the outset, we, too, reject the Tenth Circuit's application of the dangerous patient exception, which ties the standard of care exercised by a treating psychotherapist in complying with a state's duty to protect requirement, with the applicability of the psychotherapist-patient privilege in criminal proceedings. Glass, 133 F.3d at 1360 (determining that the alleged exception to the Jaffee privilege is applicable only where the threat was serious when made and disclosure is literally the only means of averting harm). We see only a marginal connection, if any at all, between a psychotherapist's action in notifying a third party (for his own safety) of a patient's threat to kill or injure him and a court's refusal to permit the therapist to testify about such threat (in the interest of protecting the psychotherapist/patient relationship) in a later prosecution of the patient for making it[, or any other prosecution for a similarly related criminal charge]. Hayes, 227 F.3d at 583-84. Advancing any connection between the standard of care exercised by a treating psychotherapist with an application of the dangerous patient exception is unsound in theory and in practice. Id. at 584. Such an inquiry would, at a minimum, be highly speculative and very likely lead to erratic results[,] as the scope of this federal testimonial privilege would vary depending upon state determinations of what constitutes reasonable professional conduct in these circumstances. Id. Second, adopting a dangerous patient exception to the psychotherapist-patient privilege would necessarily have a deleterious effect on the confidence and trust the Supreme Court held is implicit in the confidential relationship between the therapist and a patientan interest the Court also held serves public ends by facilitating the provision of appropriate treatment for individuals suffering the effects of a mental or emotional problem. Jaffee, 518 U.S. at 10, 11, 116 S.Ct. 1923; Hayes, 227 F.3d at 584-85. The dangerous patient exception to the federal testimonial privilege is quite different from a therapist's duty to protect, which is already in place. While early advice to the patient that, in the event of the disclosure of a serious threat of harm to an identifiable victim, the therapist will have a duty to protect the intended victim, may have a marginal effect on a patient's candor in therapy sessions, an additional warning that the patient's statements may be used against him in a subsequent criminal prosecution would certainly chill and very likely terminate open dialogue. Hayes, 227 F.3d at 584-85. We likewise recognize, as did the Sixth Circuit in Hayes, that there are times when a therapist can testify at a hearing and it will not have the above-mentioned deleterious effect on the confidence the therapist shares with his patient. Id. Having a therapist testify at his patient's own involuntary commitment proceedings is a different matter altogether. Testimony such as this comports with the already-existent duty to protect the patient or identifiable third parties placed on therapists generally. And, once committed, the patient's mental health care continues, quite possibly with the very same mental health professional that recommended the involuntary commitment. Id. at 585. This furthers the public interest advanced and discussed by the Supreme Court in Jaffee. Jaffee, 518 U.S. at 11, 116 S.Ct. 1923. The same cannot be said for testimony at a patient's later criminal trial, for example. [A] psychotherapist's testimony used to prosecute and incarcerate a patient who came to him or her for professional help cannot be similarly justified. Hayes, 227 F.3d at 585. Once incarcerated as the result of a criminal prosecution, the probability of the patient's mental health improving diminishes significantly and a stigma certainly attaches after the patient's sentence is served. Id. We hold, therefore, that the federal psychotherapist/patient privilege does not impede a psychotherapist's compliance with his professional and ethical duty to protect innocent third parties, a duty which may require, among other things, disclosure to third parties or testimony at an involuntary hospitalization proceeding. Conversely, compliance with the professional duty to protect does not imply a duty to testify against a patient in criminal proceedings or in civil proceedings other than directly related to the patient's involuntary hospitalization, and such testimony is privileged and inadmissible if a patient properly asserts the psychotherapist/patient privilege. Id. at 586. Thus, we do not adopt the dangerous patient exception to the federal psychotherapist-patient testimonial privilege. As such, the court erred in applying such an exception and admitting Dr. Houghton's testimony at trial. This, however, was not reversible error, as discussed below.