Opinion ID: 1177228
Heading Depth: 1
Heading Rank: 3

Heading: Applicability of Section 340.5 to LaNita's Action

Text: (3) In Tarasoff, this court held that because a psychotherapist stands in a special relationship with a person whose conduct may need to be controlled  the patient  the therapist has a duty first to exercise `that reasonable degree of skill, knowledge, and care ordinarily possessed and exercised by members of [that professional specialty] under similar circumstances' in predicting whether the patient poses a serious danger to others, and second, to exercise reasonable care to protect the foreseeable victim of that danger. (17 Cal.3d at pp. 438-439.) Among the alternative means by which the therapist may fulfill the duty to protect the victim is warning the victim of the peril. (1c) LaNita's cause of action is founded upon an alleged breach of this duty to predict, or diagnose, dangerousness, and to warn of a danger posed by a therapist's patient. We must determine whether this breach constitutes professional negligence within the meaning of section 340.5. Petitioners, claiming that a breach of the duty is ordinary, not professional negligence, rely in part on language used by the court in Tarasoff stating that a therapist must exercise reasonable care to protect the victim once under applicable professional standards he determines or should have determined that the patient poses a danger. Inasmuch as this question was not before us in Tarasoff, however, that case is not dispositive. In order to define the scope of section 340.5, we look both to the language and the history of the section. In 1975 the Legislature, as part of the Medical Injury Compensation Reform Act (Stats. 1975, Second Ex. Sess., ch. 1, § 1, p. 3949; Stats. 1975, Second Ex. Sess., ch. 2, § 1, p. 3978; hereinafter M.I.C.R.A.) adopted definitions of health care provider and professional negligence. These definitions, used throughout M.I.C.R.A., [5] were added to section 340.5 which establishes a three-year period of limitation on actions for injury or death against a health care provider based upon such person's alleged professional negligence. Petitioners unquestionably are health care providers since they are licensed or certified pursuant to Division 2 ... of the Business and Professions Code.... (§ 340.5, subpar. (1). See Bus. & Prof. Code, § 2900 et seq.) A failure to warn a third person is professional negligence, however, only if this was an omission to act in the rendering of professional services ... provided that such services are within the scope of services for which the provider is licensed.... (§ 340.5, subpar. (2).) The practice of psychology and psychotherapy for which a license is required and issued pursuant to division 2 of the Business and Professions Code are defined by that code as follows: [R]endering or offering to render for a fee to individuals, groups, organizations or the public any psychological service involving the application of psychological principles, methods, and procedures of understanding, predicting, and influencing behavior, such as the principles pertaining to learning, perception, motivation, emotions, and interpersonal relationships; and the methods and procedures of interviewing, counseling, psychotherapy, behavior modification, and hypnosis; and of constructing, administering, and interpreting tests of mental abilities, interests, attitudes, personality characteristics, emotions, and motivations. The application of such principles and methods includes, but is not restricted to: diagnosis, prevention, treatment, and amelioration of psychological problems and emotional and mental disorders of individuals and groups. Psychotherapy within the meaning of this chapter means the use of psychological methods in a professional relationship to assist a person or persons to acquire greater human effectiveness or to modify feelings, conditions, attitudes and behavior which are emotionally, intellectually, or socially ineffectual or maladjustive. As used in this chapter, `fee' means any charge, monetary or otherwise, whether paid directly or paid on a prepaid or capitation basis by a third party, or a charge assessed by a facility, for services rendered. (Bus. & Prof. Code, § 2903.) Petitioners do not deny that the duty to recognize dangerousness arises in their rendering of professional services in the practice of psychology, and thus injury to a patient proximately caused by a negligent failure to diagnose or predict such behavior constitutes professional negligence as defined in section 340.5. They argue, however, that the duty to warn a third person does not involve the rendering of professional services. In sum, petitioners' position is that professional negligence involves only acts in the course of diagnosis or treatment resulting in injury to the patient. An injury to a third person resulting from a failure to warn is ordinary negligence governed by section 340. In support of their argument, petitioners rely on Tresemer v. Barke (1978) 86 Cal. App.3d 656 [150 Cal. Rptr. 384, 12 A.L.R.4th 27]. There, discussing one count of a complaint alleging injury resulting from a physician's failure to warn the plaintiff-patient of hazards related to the use of the Dalkon Shield intrauterine device that were discovered subsequent to its insertion, the court distinguished that cause of action from those for medical malpractice: A cause of action is stated for failure to warn plaintiff. This would arise by virtue of a confidential relationship between doctor and patient. It is not a malpractice cause of action in the commonly understood sense but rather a malpractice action from the imposed continuing status of physician-patient where the danger arose from that relationship. It is also a cause of action for common negligence. The statute of limitations of section 340.5 would not apply even though the basic `injury' resulted from a medical treatment for it is a separate duty to act which is involved. (86 Cal. App.3d at p. 672.) We need not decide if Tresemer is correct in stating that section 340.5 would not apply to a failure to warn of the kind involved there. That statement is dictum since the action was commenced within one year of the date the plaintiff learned of her injury and its cause (86 Cal. App.3d at p. 665) and was barred by neither section 340.5 nor 340, subdivision (3). The case is also distinguishable in that the duty to warn was based on the defendant/physician's past professional relationship and arose long after he had treated plaintiff. Whether a failure to warn in those circumstances occurs in the rendering of professional services is not determinative of the question posed here where the duty arose and the omission to act occurred during the time that defendants were rendering professional services to Stephen. Relying principally on Tarasoff, LaNita notes that the statutory definition of professional negligence is not limited to injury or wrongful death of a patient. She argues that her cause of action sounds in professional negligence because the duty imposed on a therapist in that case is first to diagnose or recognize the danger posed by the patient and only then to warn. The warning aspect of this duty, she claims, is inextricably interwoven with the diagnostic function. We agree. We held in Tarasoff that diagnoses and predictions about the danger of violence presented by a patient must be rendered under accepted rules of professional responsibility, and that in so doing therapists must exercise the `reasonable degree of skill, knowledge and care ordinarily possessed and exercised by members of [the profession].' (17 Cal.3d at p. 438.) Diagnosis of psychological problems and emotional and mental disorders is a professional service for which a psychologist is licensed, and a negligent failure in this regard is therefore professional negligence as that term is defined in section 340.5. This diagnosis and prediction is an essential element of a cause of action for failure to warn. It is the basis upon which the duty to the third party victim is found. A negligent failure to diagnose dangerousness in a Tarasoff action is as much a basis for liability as is a negligent failure to warn a known victim once such diagnosis has been made. As LaNita notes, the decision to warn and the manner in which the warning is given may also involve professional judgment. Were we to accept petitioners' argument, the period of limitation would differ if, and could be established only when the jury determined whether, there had been a negligent failure to diagnose. The applicable statute of limitations may not be subject to such uncertainties. It must be determined on the nature of the cause of action itself, not on the basis of its components. (4) Under well established principles the applicable statute of limitations is determined by the nature of the right sued upon. ( Davies v. Krasna (1975) 14 Cal.3d 502, 515 [121 Cal. Rptr. 705, 535 P.2d 1161, 79 A.L.R.3d 807]; Day v. Greene (1963) 59 Cal.2d 404, 411 [29 Cal. Rptr. 785, 380 P.2d 385, 94 A.L.R.2d 802].) (1d) Tarasoff recognizes a right to expect that a licensed psychotherapist will realize when a patient poses a serious danger to another and, if that potential victim is identifiable, will act reasonably to protect the victim. The diagnosis and the appropriate steps necessary to protect the victim are not separate or severable, but together constitute the duty giving rise to the cause of action. Our conclusion that the term professional negligence encompasses a failure to warn third persons is consistent with and furthers the legislative purpose in adopting M.I.C.R.A. Because they involve professional negligence, actions based on failure to warn are subject to the several other restrictions on recovery that are part of M.I.C.R.A., including the limits on attorney contingent fees and recovery for noneconomic losses (Bus. & Prof. Code, § 6146; Civ. Code, § 3333.2), and reduction of damages to reflect payments received from collateral sources. (Civ. Code, § 3333.1.) [6] The Legislature stated the purpose of M.I.C.R.A. is to provide an adequate and reasonable remedy for the major health care crisis ... attributable to skyrocketing malpractice premium costs and resulting in a potential breakdown of the health delivery system, severe hardships for the medically indigent, a denial of access for the economically marginal, and depletion of physicians such as to substantially worsen the quality of health care available to citizens of this state. (Stats. 1975, Second Ex. Sess., ch. 2, § 12.5, p. 4007.) When a health care provider's professional negligence results in harm to parties other than a patient the legislative purpose of reducing health care costs by reducing the dollar amount of judgments in actions for failure to warn would be frustrated if the M.I.C.R.A. restrictions were not applicable. It would be anomalous, too, if a third party's cause of action based on the same negligent act were treated differently than an action by the patient. We conclude therefore that LaNita's cause of action is one for professional negligence and as such is governed by section 340.5.