Opinion ID: 1163272
Heading Depth: 1
Heading Rank: 4

Heading: Is There A Duty Owing?

Text: Calwell and Hall contend that Hassan had a duty to warn Rylant not to drive because her driving was a foreseeable risk to the driving public. They reason that if a doctor knows or should have known that a patient's condition might impair the ability to drive, the patient should be warned. According to Calwell and Hall, Hassan breached his duty owed to Rylant, and given the foreseeable dangerous nature of her condition, (21 Kan. App.2d at 735) he also breached a duty to the general public. A review of the elements of a negligence claim is appropriate. For negligence to exist there must be a duty owed by one person to another and a breach of that duty. The injured party must show: (1) a causal connection between the duty breached and the injury received and (2) damage from negligence. An accident which is not reasonably foreseeable by the exercise of reasonable care and prudence is not sufficient grounds for a negligence action. A fundamental rule is that actionable negligence must be based on a breach of duty. Durflinger v. Artiles, 234 Kan. 484, 488, 673 P.2d 86 (1983). A special relationship between certain persons could cause a duty. Whether a duty exists is a question of law. Whether the duty has been breached is a question of fact. Whether there is a causal connection between the breached duty and the injuries sustained is also a question of fact. 234 Kan. at 488. Our review of questions of law is unlimited. P.W. v. Kansas Dept. of SRS, 255 Kan. 827, 831, 877 P.2d 430 (1994). Without a duty there can be no breach to support the claims of Calwell and Hall. See Nero v. Kansas State University, 253 Kan. 567, 571, 861 P.2d 768 (1993). The Court of Appeals applied the Restatement (Second) of Torts § 315 and § 324A and found a duty owing. Thus, we turn to an examination of those two sections of the Restatement as applied in our cases. We begin with the observation that historically there is no general duty to act for the protection of others. We said in C.J.W. v. State, 253 Kan. 1, Syl. ¶ 2, 853 P.2d 4 (1993): As a general rule, in the absence of a `special relationship' there is no duty on a person to control the conduct of a third person to prevent harm to others. A special relationship may exist between parent and child, master and servant, the possessor of land and licensees, persons in charge of one with dangerous propensities, and persons with custody of another. The Court of Appeals found a § 315 special relationship, observing there may have been a duty to warn Rylant not to drive. 21 Kan. App.2d at 748. The Restatement (Second) of Torts § 315 (1964), 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. Comment (c) to § 315 in part explains: The relations between the actor and a third person which require the actor to control the third person's conduct are stated in §§ 316-319. [§ 316, Duty of Parent to Control Conduct of Child; § 317, Duty of Master to Control Conduct of Servant; § 318, Duty of Possessor of Land or Chattels to Control Conduct of Licensee; § 319, Duty of Those in Charge of Person Having Dangerous Propensities] The relations between the actor and the other which require the actor to control the conduct of the third persons for the protection of the other are stated in §§ 314A and 320. We recently considered the existence of a physician-patient special relationship involving a duty to warn claim under § 315 in Boulanger, 258 Kan. 289. Our holding in Boulanger is significant in the resolution of this case. See Boulanger, 258 Kan. at 304 for a list of our § 315 special relationship cases. Boulanger was shot by Hill, a patient of Dr. Pol's, 10 days after Hill's release from Applewood Care Center, Inc. (Applewood), an intermediate health care facility which Hill had voluntarily entered. Although before entering Applewood, Hill had a history of violence against Boulanger, his uncle, Hill did not indicate any intention to harm Boulanger while at Applewood. Boulanger sued Pol, Applewood's medical director, and Applewood for negligent release. Pol was Hill's primary care physician during Hill's stay at Applewood. The district court granted summary judgment for defendants. One of the issues was whether Pol and Applewood owed a duty to Boulanger based on the special relationship doctrine in § 315 of the Restatement. Boulanger argued that Pol had a duty either to detain Hill and seek his involuntary commitment or to warn Boulanger of the danger. We held that no § 315 special relationship existed. Boulanger was fully aware of his nephew's propensity for violence at the time of Hill's release. Pol and Applewood had neither a duty to warn Boulanger, nor a duty to take affirmative action to control Hill even if a special relationship under § 315 had been established. 258 Kan. at 308. We further determined that neither Pol nor Applewood had the requisite control of Hill which might create a duty under § 319 (duty of those in charge of a person having dangerous propensities). 258 Kan. at 308. Thus, no special relationship existed imposing any duty under § 315. None of the Kansas cases in which a special relationship has been found concern medical doctor/outpatient relationships. We are aware that Mahomes-Vinson v. U.S., 751 F. Supp. 913 (D. Kan. 1990), did find a § 315 special relationship between a psychotherapist and a voluntary mental patient in a negligent release case arising from the rape, sodomy, and murder of two young girls. The Mahomes-Vinson court noted that the records indicated the mental patient had 90 incidents involving sexual deviance or violent behavior since beginning treatment at the Veterans Administration (VA). The patient's wife stated he had fantasies about little girls 2 weeks before the murders. The patient told the supervising physician prior to release that I need to stay away from little girls. 751 F. Supp. at 916. A psychiatrist opined thatthe patient should have been involuntarily committed at the time of his release and that the two murdered children were identifiable as potential targets at the time of discharge. Mahomes-Vinson focused on the VA's duty to detain its mental patient, possibly even to the extent of seeking involuntary commitment. Mahomes-Vinson is distinguished from this case. Only in C.J.W., 235 Kan. 1; Cansler v. State, 234 Kan. 554, 675 P.2d 57 (1984); and Washington v. State, 17 Kan. App.2d 518, 839 P.2d 555, rev. denied 252 Kan. 1095 (1992), (all involving juvenile or adult incarceration settings) was there a finding of a special relationship creating any duty under § 315. In Boulanger, we decided that a psychiatrist owed no affirmative duty to the injured plaintiff with respect to a voluntary mental patient. 258 Kan. 289. In Nero, 253 Kan. 567, we found that a material issue of fact remained about whether Kansas State University (KSU) owed Nero a duty under a landlord-tenant theory, not under § 315. Nero, a female student, was sexually assaulted in a KSU residence hall by Davenport, a male co-resident. She sued KSU for negligence, alleging KSU had a duty to protect her against Davenport's assault. At the time of the assault, Davenport had a rape charge pending against him for an incident with another female student in a different residence hall. The district court granted KSU's motion for summary judgment. On appeal, Nero argued that KSU took charge of Davenport and was under a duty to exercise reasonable care to control him and prevent him from physically harming others because the university knew or should have known he was likely to cause such harm. The legal basis for argument is Restatement (Second) of Torts § 315(a), 319 (1964). 253 Kan. at 581. We disagreed, holding that KSU did not have the type of control or custody over Davenport contemplated by § 315. 253 Kan. at 582. We have imposed a § 315 duty only in situations involving a dangerous person in a custodial setting. Finding no direct Kansas authority supporting the existence of a § 315 special relationship between a medical doctor and patient in an outpatient setting, the Court of Appeals was most persuaded by two duty to warn cases cited by Calwell and Hall: Duvall v. Goldin, 139 Mich. App. 342, 362 N.W.2d 275 (1984), and Myers v. Quesenberry, 144 Cal. App.3d 888, 193 Cal. Rptr. 733 (1983). 21 Kan. App.2d at 739. The pivotal role played by Duvall and Myers in the Court of Appeals' opinion invites comment on the two decisions. Alice and William Duvall were injured when their car was hit by a car driven by Hubbard, who was an epileptic. The Duvalls sued Hubbard and later, Dr. Goldin, the physician treating Hubbard, claiming Goldin owed a duty to persons on the public highway to properly treat Hubbard. Goldin had breached that duty by failing to prescribe and continue Hubbard on anti-epileptic medication and to instruct Hubbard not to drive after removing Hubbard from the medication. The trial court granted summary judgment for Goldin. The Court of Appeals of Michigan reversed, relying on: (1) § 315 of the Restatement, (2) Tarasoff v. Regents of University of California, 17 Cal.3d 425, 131 Cal. Rptr. 14, 551 P.2d 334 (1976) (decedent's killer confided intention to kill decedent to therapist; therapist held to have special relationship duty to warn readily identifiable victim of patient's violent intentions), and (3) Davis v. Lhim, 124 Mich. App. 291, 335 N.W.2d 481 (1983) (psychiatrist held to owe duty to exercise reasonable care to protect decedent against dangerous tendencies of patient). The Duvall court found a § 315 duty owing under circumstances beyond those provided in §§ 314A or 316 through 320. Duvall relied on the dangerous person theory, i.e., Hubbard (who had had previous epileptic seizures) was a dangerous person when removed from his anti-epileptic medication. 139 Mich. App. at 350. Duvall is factually distinguishable. Rylant was not a dangerous person. She had not been removed from medication required to prevent seizures. She told Hassan at the time she first sought treatment that she had to fight to stay awake while driving. She never told Hassan that she had fallen asleep without warning while driving. Rylant responded positively to Hassan's treatment over 37 months, although she periodically returned to see him for recurrences of drowsiness, and her medication was modified. We find no evidence in the record creating a material fact issue as to whether Hassan improperly diagnosed or treated Rylant's daytime drowsiness condition. While a person prone to an epileptic seizure without warning might be viewed as potentially dangerous to others in certain situations (such as driving), Rylant's symptoms during the time she saw Hassan did not show she posed a danger to others. While under Hassan's treatment, she had been driving for over 3 years without incident. She also knew that she should pull over if she felt drowsy. Myers is also distinguishable. Myers was struck by a car driven by Hansen, who, while pregnant, was suffering a diabetic attack. Hansen had seen her doctor, who advised her that her fetus was dead and needed to be removed within 18 hours. Hansen became emotionally upset. She was advised by the doctors to drive immediately to the hospital for preliminary lab tests. The accident occurred thereafter. The Myers court could not tell whether the collision occurred between the doctors' office and the hospital or after Hansen left the hospital. The complaint against Hansen's physicians alleged that they had negligently failed to control her conduct by allowing her to drive to and from the hospital and failing to warn her not to drive in an irrational and uncontrolled diabetic condition. She lost control of her car while having a diabetic attack. The trial court dismissed the complaint. Relying on Tarasoff, the California Court of Appeal reversed. Myers does not reference § 315. The liability issue analysis in Myers is grounded on policy considerations. The question of negligence liability is more accurately analyzed when the word `duty' is eliminated, with the focus solely on the issue of whether liability should be imposed. This issue, in turn, is best analyzed by determining whether public policy considerations justify making an exception to the general rule of liability. 144 Cal. App.3d at 891. As in Duvall, Myers reached beyond § 315 to find a special relationship and accompanying duty in the medical doctor/outpatient setting. Liability was based on the doctor's failure to warn the patient not to drive. Section 315 liability arises from either of two special relationships: (a) one between the doctor and the patient imposing a duty to control the patient, or (b) one between the doctor and the person injured by the patient's conduct imposing a duty to protect the injured person. The special relationship here concerns the one between Hassan and Rylant, not Hassan and Calwell and Hall. Calwell and Hall do not claim Hassan had a duty to warn them. The Court of Appeals distinguished a line of cases cited by Calwell and Hall concerning a physician's duty to warn others of the spread of infectious diseases, stating: The issue in the present case is not the failure of Hassan to warn the plaintiffs, but his alleged negligence in failing to warn Rylant. 21 Kan. App.2d at 741. Section 315 says nothing about a duty to warn the person who is the active force in causing the injury. Instead, it discusses a duty to control such person or a duty to protect the injured person. The only basis for imposing a special relationship duty under § 315 in this case is under the theory that Hassan's actions created a risk of harm to Calwell and Hall. Rylant already was aware of her daytime drowsiness problem at the time she first sought treatment. Rylant also knew that she should pull over if she felt drowsy while driving. There was no evidence that the medication Hassan prescribed for Rylant caused or worsened her daytime drowsiness problem. She had been taking the same level of medication for slightly over a year before the accident. Rylant testified she was feeling fine and had no problems between August 22, 1990, and July 29, 1991. 21 Kan. App.2d at 731. According to the PDR excerpts submitted by Calwell and Hall, Hassan's prescription levels for Elavil and Prozac were within the recommended dosages. We find no issue of material fact about whether Hassan's conduct created a risk of harm to Calwell and Hall. We have found a duty owing under § 315(a) only in situations in which the party owing the duty did have the ability or right to control the third person causing the harm. See Boulanger, 258 Kan. 289, P.W., 255 Kan. 827, and C.J.W., 253 Kan. 1. Calwell and Hall concede that Hassan had no duty to control Rylant but rather a duty to warn. Our § 315 analysis in Boulanger is applicable, to the disposition of the § 315 issue here. We find no special relationship between Hassan and Rylant exists, under Restatement (Second) of Torts § 315 imposing on Hassan a duty to warn Rylant not to drive. As we noted in Boulanger, our § 315 cases are fact specific. 258 Kan. at 304. The uncle in Boulanger knew of his nephew's dangerous attitude. Here Rylant knew she might become drowsy or fall asleep while driving. We held in Boulanger that Pol had no duty to warn the uncle of what the uncle already knew. 258 Kan. at 307. Hassan had no duty to warn Rylant of what she already knew. We acknowledge that Boulanger concerned the injured uncle's knowledge of the risk. Here, Rylant knew the risk of falling asleep, but she caused the injury. However, the concept that there is not a duty to warn someone of what they already know applies to both cases.