Court Opinion

ID: 9670342
Source: CourtListenerOpinion
Date Created: 2023-08-24 03:19:10.989353+00
Date Added: 2024-06-11T09:42:31.993420
License: Public Domain

STEINMETZ, J.
(concurring). The facts of this case are different from those in the typical physician malpractice case. The plaintiff is not the patient; the claim is brought by third parties to the physician-patient relationship. The claim is not brought to redress injury suffered directly by the patient, but rather it is brought to seek compensation for injury suffered by a third party, allegedly as a result of the doctor’s negligent diagnosis or treatment of the patient.
I agree for the reasons set forth in the majority opinion that this case raises factual issues as to whether Dr. Altenberg was negligent in diagnosing and treating Edith Schuster and, if so, whether the misdiagnosis and improper treatment were substantial factors in causing the accident and consequential injuries. I further agree that if Dr. Altenberg breached his duty of care in diagnosing and treating Edith *264Schuster, he is potentially liable to unforeseen plaintiffs for unforeseen consequences. The jury may have to determine factual issues regarding the alleged failure to warn the patient of the side effects or risks associated with any medication prescribed. Thus, I agree that the trial court erred in granting defendants’ motion on the pleadings, because plaintiffs did state a legally recognized claim for malpractice in the portion of the complaint alleging negligent diagnosis and treatment.
However, I believe that the majority goes too far in its holding, at least under the limited facts presented in the pleadings of this case, that a claim for relief was stated in the allegations that Dr. Altenberg negligently failed to warn the patient’s family of her condition and that he failed to institute commitment proceedings for Edith Schuster. Contrary to the majority’s assertion, the current law of negligence in Wisconsin is not so broad as to automatically encompass these claims. I firmly believe that this court is ill-advised to broaden the basis for a psychotherapist’s liability to third parties under the concededly "sparse” facts alleged in the complaint.
All we know about this case is that the plaintiffs mother, who had received psychiatric care from a psychiatrist on a voluntary outpatient basis, had a single-car accident resulting in her death and in plaintiffs tragic injuries. On this information alone, the majority makes sweeping pronouncements about third-party liability of therapists for failure to warn others about their patients and failure to confine patients. This case is simply not ripe — from a factual perspective — to determinate these issues, notwithstanding any encouragement offered by the parties to do so.
*265It may be true that Wisconsin law would permit a holding that a psychiatrist or psychotherapist has a duty of some type to warn third parties of a dangerous patient or, when necessary, to institute detention or commitment proceedings in order to confine a dangerous individual for the protection of the patient or third parties. However, this is not the same as saying, as does the majority, that Wisconsin negligence law precludes a holding that a psychotherapist does not have a duty to warn third parties or to confine a dangerous patient. See Majority opinion at pages 239-40. Under the majority's view, Wisconsin law not only allows such a holding but requires it. Such is not the case.
Furthermore, the majority goes beyond merely holding that a therapist’s duty exists with respect to third parties; it proceeds to suggest, in general terms at least, what the scope of that duty is to be. The problems generated by the primarily dictum opinion are not saved by the disclaimer that expert testimony will be required to establish the standard of care.
Notwithstanding the majority’s assertion to the contrary, it may well be appropriate to "engage in analytical gymnastics” to examine the existence of a duty as it relates to third parties to the physician-patient relationship. Majority opinion at page 238, n. 3. The concept that a person generally owes no duty to control the conduct of another has never been abrogated and replaced by "an imposition of an affirmative duty to act” (Majority opinion at page 13) in all cases where a third party is harmed, whether negligently or intentionally, by a patient. Certainly, before it is found that a psychotherapist has a duty to a third party to control the actions of his patient through confinement, it must, at a minimum, be established *266that the therapist had an ability and a right to do so. Moreover, if the complaint is based on dangerousness, there should at least be required a reasonable inference that the patient was dangerous in the first instance, and the allegation of dangerousness must be based on something more than the fact that the person was being treated as an outpatient by a mental health practitioner. In addition, sec. 51.20(l)(a)l, Stats., requires the individual be mentally ill as well as dangerous.
Although it is true that A. E. Investment characterized Wisconsin negligence law as following the minority position in Palsgraf, the law in Wisconsin is more properly characterized as following neither the Cardozo majority in Palsgraf, which predicated liability on a very narrowly drawn scope of duty, nor the Andrews’ dissent in Palsgraf which limited liability in negligence through causation based on policy factors. Rather, Wisconsin has actually followed its own distinct approach and limited liability through policy considerations after the elements of duty and causation have been established. See generally Comment, The Existence of a Duty in Wisconsin Negligence Cases, 61 Marq. L. Rev. 447 (1978).
We have previously stated that policy considerations limiting liability generally are best determined only after a full resolution of the issues at trial. Coffey v. Milwaukee, 74 Wis. 2d 526, 543, 247 N.W.2d 132 (1976). The majority cites three cases in which this court has previously determined a defendant’s liability without the benefit of a full trial. However, those cases are quite distinguishable from the present case in at least two critical respects.
First, in each of those cases the court applied public policy considerations to limit a defendant’s *267liability, not to expand it. The court was effectively saying that under no conditions, regardless of any particular facts that might be revealed in the discovery process or at trial, would the plaintiff be permitted to recover because public policy precluded holding the defendant liable. This is quite different than speculating at the complaint stage what the policy considerations would be and then proceeding to decide the policy issues.
Second, in each of the cases cited by the majority, the complaint alleged facts sufficient to make a policy determination. Such is not the case here. In one of the very cases cited by the majority, Hass v. Chicago & North Western Ry. Co., 48 Wis. 2d 321, 327, 179 N.W.2d 885 (1970), this court stated that: "There may well be cases, of course, where the issues are so complex, or factual connections so attenuated, that a full trial must precede the court’s determination.” The case at bar certainly presents complex and competing policy considerations; as such, this court is better advised to refrain at this point from making broad and sweeping pronouncements indicating how those considerations would be resolved if we had more facts.
Given that this case is returning to the trial court for a determination of Dr. Altenberg’s negligence on the first theory of liability, it was unnecessary, as well as imprudent, for the majority to expound for three-quarters of the opinion on the two other bases for liability, both of which require substantial speculation.
The plaintiffs will be given ample opportunity to prove their case. It may well be that the legal issues with respect to failure to warn and failure to confine become moot as the facts become known. That is, if all *268that is shown on discovery or at trial is that Mrs. Schuster was negligent in causing her daughter’s injuries, then I would hold that there was no duty on the part of the doctor regarding failure to warn others and failure to seek the patient’s confinement. The complaint sues for injuries sustained in an automobile accident1 and there is no duty to predict negligent conduct. The pleadings in this case were inadequate and factually incomplete to serve as the basis for the policy determinations made by the majority. I would send the case back to the trial court with directions to permit the plaintiffs to amend their complaint.
Moreover, were I tempted to apply the public policy considerations as was done by the majority, I would resolve them in favor of the defendant, Dr. Altenberg. What we have here is a plaintiff injured through an ordinary car accident. There is no allegation or even an intimation in the complaint that Edith Schuster was homicidal, suicidal, or otherwise intended or desired to harm her daughter or herself. Any discussion about a psychotherapist’s liability for failure to protect third parties from a dangerous patient *269by its very nature implies that the claim is predicated upon the patient’s intentional acts. The Tarasoff decision and its progeny all dealt with dangerous patients who intentionally harmed victims. This complaint, under the most liberal construction possible, does not even remotely suggest that there was any intentional behavior on the part of Edith Schuster, a voluntary outpatient in therapy, from which the plaintiff or anyone in the world needed protection. The majority would apparently hold psychotherapists to the duty of assessing a patient’s potential for negligent behavior as well as for dangerousness.
Finally, in addition to considering prematurely several important public policy factors, the justification used by the majority to so easily dispense with the critical policy consideration of physician-patient confidentiality is suspect, at best. Section 905.04, Stats., of the Evidence Code is a specifically drawn exception to the physician-patient privilege of confidentiality and is to be narrowly construed. See Alexander v. Farmers Mut. Automobile Ins. Co., 25 Wis. 2d 623, 628, 131 N.W.2d 373 (1964). Not every psychotherapist-patient relationship involves a mental illness or communication which will even implicate sec. 905.04. More importantly, this exception enables the treating physician legally to breach the patient’s trust and divulge very private information received during psychotherapy when he or she deems it necessary and appropriate to institute commitment proceedings. The exception was not drawn to enable a battery of medical expert witnesses to expose the same privileged information received in confidence from a patient who was not involuntarily committed in a civil proceeding against the patient’s therapist to prove in retrospect that the patient should have been confined. Nor does the APA *270Code of Ethics authorize such a breach of confidentiality. What the majority conveniently overlooks is that both sec. 905.04 and the APA code recognize, in limited instances and for a limited purpose, the psychiatrist himself or herself may sometimes find it necessary to reveal patient confidences. It does not authorize others to use the information against the psychiatrist nor does it compel the psychiatrist to divulge privileged information. Any reliance on these codes is misplaced. The competing considerations of patient confidentiality and the need to protect society are not so easily resolved, nor should they be so summarily dismissed, particularly when a decision of these issues arguably implicates a far broader range of professional-client communication.
The issues of the existence and scope of a psychotherapist’s duty to third parties for dangerous patients’ intentional behavior pose interesting and important questions. However, those questions do not appear to me to be implicated here. I am reminded by this case of the court’s statement in Wilson v. Continental Insurance Cos., 87 Wis. 2d 310, 326-27, 274 N.W.2d 679 (1979) as follows: "Under the guise of notice pleading, the complaint before us requires the court to indulge in too much speculation leaving too much to the imagination of the court.” Such is the case here. Were this complaint not saved by the allegations of negligent diagnosis and prescription of medication, I would resolve it in favor of Dr. Alten-berg and affirm the decision of the trial court. Given that the plaintiffs do have the opportunity to prove their case, however, I would refrain at this point from deciding issues that are not clearly implicated in this case.
*271I am authorized to state that JUSTICES SHIRLEY S. ABRAHAMSON and WILLIAM A. BAB-LITCH join this concurring opinion.

The relevant portions of the amended complaint state:
"4) On July 29,1983, GWENDOLYN SCHUSTER was badly injured in an automobile accident in Racine County wherein her psychiatrically ill mother, Edith Schuster, a patient of DR. ALTENBERG, was driving the car and was fatally injured.
"5) DR. ALTENBERG was negligent in his management and care for Edith Schuster in failing to recognize or take appropriate actions in the face of her psychotic condition, including failing to seek her commitment, to modify her medication, to alert and warn the patient or her family of her condition or its dangerous implications, and that this inappropriate care was a substantial contributing factor in causing the automobile accident and the injuries and damages sustained by the plaintiffs.”