Opinion ID: 462582
Heading Depth: 2
Heading Rank: 1

Heading: The Hospital's Duty to Warn

Text: 10 The appellant's first claim is that the Hospital had a duty to warn her that Dwayne White harbored hostility toward her and therefore posed a threat to her safety. In particular, it is appellant's view that Dwayne White's fantasy of harming his wife with a gun was a genuine threat that should have been relayed to the Hospital Administration and to appellant after her husband told Dr. Brown about the fantasy. 11 The duty to warn foreseeable victims of mental patients originated in Tarasoff v. Regents of the University of California. 2 In that case, the California Supreme Court held that the special relationship between a patient and a psychotherapist creates a duty to third persons. When a psychotherapist determines--or under the standards of the profession should have determined--that a patient presents a serious danger of violence to another, the psychotherapist bears a duty to exercise reasonable care to protect the foreseeable victim of that danger. 3 As in Tarasoff itself, this duty will often include an obligation to warn the intended victim, but only if the victim is identifiable. 4 12 The Tarasoff rule has been followed in a number of jurisdictions, and in at least one decision this court has upheld a similar duty to warn against the District of Columbia. 5 The trial in this case apparently proceeded on the assumption that the appellees owed a duty to warn; we have no reason to doubt the validity of that assumption. 13 In defining the duty to warn, the courts have made it clear that the duty is not triggered by the mere existence of a threatening statement by a patient to his psychotherapist. Such statements are commonly expressed to psychiatrists and merely pose but do not answer the difficult question of whether or not danger is actually present. 6 Before a hospital or psychotherapist incurs an obligation to warn, the patient must present a serious danger of violence to a foreseeable victim of that danger. 7 Furthermore, in determining whether the Hospital should have warned appellant, this court must focus on whether Dr. Brown's handling of the fantasy was consistent with the standards of her profession. As the Tarasoff court noted: 14 Obviously we do not require that the therapist, in making [the determination of dangerousness], render a perfect performance; the therapist need only exercise that reasonable degree of skill, knowledge, and care ordinarily possessed and exercised by members of [that professional specialty] under similar circumstances. 8 15 In sum, we must determine whether Dr. Brown exercised the reasonable skill, knowledge and care ordinarily possessed by members of her profession when she concluded that the fantasy reflected no danger to Genoa White. 16 We conclude that the District Court's finding that Dr. Brown's assessment of the fantasy was reasonable is not clearly erroneous. Dr. Brown gave a detailed and persuasive explanation of why the single fantasy did not reflect a danger to Genoa White. She testified that she considered the fact that Dwayne White himself recognized these thoughts as a fantasy and that he was able to distinguish between fantasy and acting on his fantasy. Additionally, she noted that Dwayne White had not had any violent incidents for close to a year and had no history of assaulting women. Dr. Brown's testimony was buttressed by Dr. Miller, the Hospital's expert witness, who concluded that Dr. Brown's assessment was a reasonable one under the standards of her profession. He further testified that, as Dwayne White's psychotherapist, Dr. Brown was in the best position to assess the fantasy. Although Dr. Madsen, a member of the Hospital staff who conducted an evaluation of Dwayne White in the fall of 1979, testified that he would have strongly lobbied for a restriction of privileges had he known about the fantasy at the time of the testing, 9 his knowledge of the fantasy was only second-hand and thus his testimony is not otherwise sufficient to overcome Dr. Miller's testimony that Dr. Brown's assessment was reasonable. 10 17 We also reject appellant's suggestion that the T/A split policy was itself an unreasonable practice. Although Dr. Blumberg, the appellant's expert, testified that the use of the T/A split is a ludicrous practice in a maximum security setting, we hesitate to second-guess the wisdom of an essentially medical decision in the face of ample evidence in the record that a T/A split is a common practice at similar institutions. Dr. Miller testified that the T/A split as performed at St. E's Hospital is consistent with the usual and appropriate practice of individual psychotherapy in an institutional setting and noted that the T/A split was used at other institutions including Yale, Connecticut Mental Health Center and Westhaven Veterans Administration Hospital. 11 18 In summary, although St. Elizabeths may be obligated to take reasonable steps--including warnings--to protect foreseeable and identifiable victims from a serious danger of violence presented by its patients, Dwayne White's fantasy presented no such danger to Genoa White.