Court Opinion

ID: 9548305
Source: CourtListenerOpinion
Date Created: 2023-08-07 18:01:20.572292+00
Date Added: 2024-06-11T15:18:47.047832
License: Public Domain

VOLLACK, Justice,
dissenting:
I dissent from the majority opinion because I would hold as a matter of law that Dr. Anders and the state did not owe a legal duty to Officer Perreira under these circumstances. While I do not agree entirely with the court of appeals’ analysis, I would affirm the court of appeals’ conclusion that “the trial court erred in finding that the State had a legal duty to Officer Perreira and his survivors.” Perreira v. State, 738 P.2d 4, 6 (Colo.App.1986).
I.
Negligent Release
The plaintiff’s claim is not that Dr. An-ders negligently failed to warn Officer Per-reira, or police officers in general, of alleged threats by Buckmaster. Rather, the claim is that Dr. Anders negligently released Buckmaster from his involuntary mental health commitment at Fort Logan Mental Health Center (FLMHC) and, presumably, that this alleged negligence was the proximate cause of Officer Perreira’s death four months later. I agree with the majority that traditional tort analysis applies to the issue of negligent release, incorporating foreseeability and other factors into the larger question of duty. I do not agree, however, that the determination of duty rests so heavily on Buckmaster’s classification as an involuntarily committed inpatient. At 1212-1214. Littleton v. Good Samaritan Hosp. & Health Center, 39 Ohio St.3d 86, 90, 529 N.E.2d 449, 453 (1988) (The plaintiff, administrator of the victim’s estate, alleged that the negligence of the physician and hospital in releasing the patient from the hospital was the proximate cause of the death of the patient’s daughter. The patient’s hospitalization was voluntary but the court held: “Even though Theresa was a voluntary patient, we find that Dr. Murray had sufficient charge of Theresa in the hospital setting such that a special relation was established.” Id. at 92, 529 N.E.2d at 455.).
Instead, I would focus on the distinction between negligent release of a patient, and failure to warn persons who might foresee-ably be injured. Other jurisdictions have recognized this distinction. See Soutear v. United States, 646 F.Supp. 524, 532 (E.D.Mich.1986) (applying Michigan law) (“Plaintiff’s claim is based on two theories of negligence. First, that the doctors at the Allen Park VA hospital were negligent in releasing [the patient] because he posed a risk of violence to his parents, and second, that the doctors negligently failed to warn the [parents] that they were potential victims.” (Emphasis added.)); Durflinger v. Artiles, 234 Kan. 484, 485, 673 P.2d 86, 89 (1983) (“Would the Kansas Supreme Court recognize as a valid cause of action a claim which grew out of a negligent release of a patient who had violent propensities, from a state institution, as distinguished from negligent failure to warn persons who might be injured by the patient as the result of the release?” (Emphasis added.)); see also Tarasoff v. Regents of the Univ. of Cal., 17 Cal.3d 425, 431, 131 Cal.Rptr. 14, 20, 551 P.2d 334, 340 (1976) (“Plaintiffs’ complaints predicate liability on two grounds: defendants’ failure to warn plaintiffs of the impending danger and their failure to bring about Poddar’s con-finement_” (Emphasis added.)). See generally Annotation, Liability of One Releasing Institutionalized Mental Patient for Harm He Causes, 38 A.L.R.3d 699 (1971).
II.
Duty
A. Foreseeability
Traditional tort analysis requires the existence of a duty, breach of the duty, a *1222showing that this breach was the proximate cause of the plaintiff’s injuries,1 and damage. The question whether there is a duty owed by the defendants to the plaintiff is a question of law. Taco Bell, Inc. v. Lannon, 744 P.2d 43, 46 (Colo.1987). “Where a person should reasonably foresee that his act, or failure to act, will involve an unreasonable risk of harm to another, there is a duty to avoid such harm.” This duty extends to a third person if there is “a special relation between the actor and the wrongdoer or between the actor and the victim.” Leake v. Cain, 720 P.2d 152, 160 (Colo.1986); Restatement (Second) of Torts § 315 (1965).
1.
“[Fjoreseeability alone does not establish the existence of a duty.” Taco Bell, 744 P.2d at 49. While a duty may arise if foreseeability has been established, other factors also enter into the legal determination of whether a duty exists. Id. at 49 n. 6. These factors may include but are not limited to “ ‘the risk involved, the foreseeability and likelihood of injury as weighed against the social utility of the [defendant’s] conduct, the magnitude of the burden of guarding against injury or harm, and the consequences of placing the burden upon the [defendant].’ ” Id. at 46 (quoting Smith v. City & County of Denver, 726 P.2d 1125, 1127 (Colo.1986)).
Other jurisdictions have specifically analyzed foreseeability in the mental health setting in determining whether a legal duty existed.
[A] hospital may be held liable for the negligent release of a mental patient only when the hospital, in exercising medical judgment, knew or should have known that the patient, upon his release, would be very likely to cause harm to himself or others. Such likelihood must be more than a mere possibility and not based on hindsight.
Leverett v. State, 61 Ohio App.2d 35, 41, 399 N.E.2d 106, 110 (1978). “A claim of negligence [in discharging a patient] must be considered in light of the elusive qualities of mental disorders and the difficulty of analyzing and evaluating them.” Hicks v. United States, 511 F.2d 407, 415 (D.C. Cir.1974); see Lipari v. Sears, Roebuck & Co., 497 F.Supp. 185 (D.Neb.1980) (applying Nebraska law) (“[T]he Nebraska Supreme Court would ... limit the therapist’s liability to those persons foreseeably endangered by the V.A.’s negligent con-duct_ [T]he plaintiffs ... must prove that the risk created by the V.A.’s negligence was such that, under the circumstances, the V.A.’s employees could have reasonably foreseen an unreasonable risk of harm to the Liparis or a class of persons of which the Liparis were members.” Id. at 194-95 (footnote and citations omitted) (emphasis added).); Cain v. Rijken, 74 Or. App. 76, 80, 700 P.2d 1061, 1064 (1985) (“[I]f Providence [Medical Center] had knowledge of Rijken’s illness, past actions and condition at the time of the injury, it would have notice that reckless driving could be a foreseeable consequence of Rijken’s disease.” (Emphasis added.))
In assessing foreseeability, most cases rely heavily on a patient’s known “violent propensity.” Durflinger v. Artiles, 234 Kan. at 485, 673 P.2d at 89. In Durflinger, the patient had previously attacked his relatives “armed with a hatchet and a meat fork [with the] intention to kill his grandparents and steal their automobile.” Id. at 485, 673 P.2d at 90. The patient “was committed to the hospital because he was dangerous to other persons.” Id. at 486, 673 P.2d at 93. In Pangburn v. Saad, 73 N.C.App. 336, 326 S.E.2d 365 (1985), the patient was involuntarily committed after he was examined and found to be “suicidal, dangerous to himself and others, and to have threatened physical harm to his family and others.” Id. at 347, 326 S.E.2d at *1223372. In Homere v. State, 79 Misc.2d 972, 361 N.Y.S.2d 820 (1974), the patient’s records contained “innumerable entries relating to acts of aggression, clearly evincing that he was an extremely violent, as-saultive man, who attacked females without reason, cause or justification.” Id. at 974, 361 N.Y.S.2d at 822. In Williams v. United States, 450 F.Supp. 1040 (D.S.D. 1978) (applying Federal Tort Claims Act), the court held that the hospital had a duty to notify county authorities of the patient’s release because the patient “had to be placed in the locked wards of VA hospitals because of violent behavior and threatened violence.” Id. at 1041. “[The patient] Alonzo Bush initiated, threatened or was involved in several fights, threatened to kill members of his own family, made oral threats of violence toward hospital staff and police, [and] threatened a YA doctor with a scissors_” Id. at 1041 n. 1.
2.
Here, the record does not show that Buckmaster had a known violent propensity. The first time Buckmaster was hospitalized at Fort Logan Mental Health Center was in February 1975, when he was treated for about two months. He was hospitalized in a Kansas Veteran’s Administration Hospital for approximately six months in 1976. Buckmaster was not seen again at FLMHC until May 1979. This contact arose from Buckmaster’s alleged “beating” of his father. Dr. Vollman questioned Buckmaster’s sister, who was present during this incident. She told Dr. Vollman that “the father threw an ashtray at the patient and the patient kicked the father, [and] there was a screaming and shouting as well.” After a seventy-two-hour hold and evaluation it was determined that Buckmaster was not dangerous to himself or others and was not gravely disabled. He was released. In August 1979 Buck-master underwent another seventy-two-hour hold and evaluation. Again it was determined that, although mentally ill, Buckmaster was not gravely disabled or a danger to himself or others. In October 1979, however, Buckmaster was evaluated as gravely disabled and certified for short-term care and treatment.
Dr. Vollman was Buckmaster’s clinical psychologist at FLMHC throughout his treatments in 1975 and 1979. She was on the “treatment team” that was treating Buckmaster. Dr. Anders was the head of the team. A report prepared by Dr. Voll-man showed that in May 1979, Buckmas-ter’s sister reported to FLMHC that Buck-master had “become increasingly withdrawn” and was “showing no regard for his personal appearance.” Buckmaster’s sister also explained that Buckmaster and his father “had had a continuing feud from the time that [Buckmaster] was a teenager until this time in his life.” Dr. Vollman testified that “[the police] were one of a number of group[s] of people who[m] he felt were causing him difficulty.”
When Dr. Vollman saw Buckmaster in August 1979 she said that “instead of believing that there was a general class of people who were trying to make life difficult for him, officials, friends, family, police, he still was as much concerned about car mechanics and what they were doing to his car” because he believed that “[the police] and car mechanics were making his vehicle difficult to operate.”
When Buckmaster was admitted to FLMHC in October 1979, Dr. Vollman said “there was a very striking difference” in his condition; that he came to his interview “filthy, [and] smelling” and that his “thinking was much more disorganized.” By this time Buckmaster was “spending almost all the time sleeping on the streets, on the sidewalks, in doorways, or staying in all-night restaurants.” Dr. Vollman explained that Buckmaster had “not had a bath for quite some time” and that he told her “he would go for forty-five days without eating.” She summarized: “If we look at how he has changed between May and October, clearly in May he was much more able to take care of himself, to feed himself, to bathe himself, to find shelter.” This inability to care for himself was the basis for his involuntary admission as a gravely disabled mentally ill individual.
*1224Between October and December 1979 Buckmaster was an inpatient at FLMHC and underwent therapy there. Even the plaintiffs psychiatric expert testified that Buckmaster’s condition improved during this time, despite his refusal to voluntarily take medication. On December 11, Dr. Vollman determined that Buckmaster “no longer had the criteria for being an involuntarily [sic] patient according to the law” and told him that if he did not want to remain at the hospital as a voluntary patient she “had no choice but to let him go.” On December 11 she noted that “ ‘[s]ince patient refuses all treatment[2] which might significantly alter his condition, improvement at this time is probably maximal.’ ”
Dr. Sundell testified as an expert for the plaintiff. Dr. Sundell’s testimony was that Doctors Anders and Vollman failed to make a sufficient evaluation of Buckmaster “as to whether in fact he was or was not certifiable on the grounds of being dangerous to himself or others at that particular time.”
Dr. Vollman testified that Buckmaster “never committed an act of violence, unless we look at the time he kicked his father in the shins.” She described their evaluation of Buckmaster in this way:
[A Dr. Vollman:] And on no occasion— and we specifically and very directly asked him about his plans and feelings— did he feel like hurting these people, particularly the police who were trying to mess around with his life, and he absolutely denied that.
Q Can you give us some examples of how you did explore that with Mr. Buck-master?
A We certainly asked him direct questions about that: Do you have any plans? Have you ever thought of hurting anybody?
But we certainly asked him clearly and carefully: What kind of violent behavior have you engaged in in the past? Have you ever hurt anybody? Have you ever gotten into a barroom fight? Have you ever hurt anybody with a gun? Since you have owned a gun, have you ever shot at anybody? Have you ever hurt anybody with that?
His answer to all of these questions was, “No.” In fact, the information he gave me was that he had never even shot the gun that he owned.
Q Did you do anything to corroborate any of the information or to check it out to see if Mr. Buckmaster was telling you the truth?
A All of my phone calls to — I called the Englewood Police Department, the Littleton Police Department, Aurora Police Department, Glendale Police Department, attempting to get information from them if in fact he had ever been arrested for a violent crime, and their answer was, “No.”
I talked to his sister and very specifically asked her if she was aware of the fact that he owned a gun. Had he ever hurt anybody with it? Did she know, or did any of the other relatives who had talked to her about his recent behavior— by “recent” I mean from 1977 to 1979— were they aware of any time he had ever hurt anyone, and she said, no, that as far as she knew, the only violent act was to kick his father in the shins.
We tried also to get information from the Veterans’ Administration Hospital, and even though we were unsuccessful in getting detailed records from them, the Mental Health Center was willing to share, at least read some parts of the records they had from the Veterans’ Administration Hospital to us.
So, to the best of my knowledge, he had never committed a violent act in the past.
Q Did the information the V.A. Hospital gave you relate in any way to violence?
A We asked very specifically, were they aware — had he come into the hospital as a result of a violent act, or had he hurt anybody that was in the hospital. That was one thing that seemed very *1225important for us to know the first time he came in, and they said, no.
Dr. Anders also testified that the “only episode [of violence] I know is when his father threw an ashtray at him, and that altercation occurred prior to his first admission.”
Dr. Sundell conceded “changes and improvement” in Buckmaster’s condition during his hospitalization from October to December 1979 despite the fact that he refused medication. When Buckmaster was released from FLMHC in December 1979 he was 46 years old and had “[n]o significant history” of alcohol or drug abuse. At the time of his release, his arrest history was limited to charges of loitering, trespassing, carrying a concealed weapon, and driving with a suspended license. On cross-examination this exchange took place:
Q. [defense counsel] Finally, doctor, am I correct that it is not your opinion ... based on a reasonable degree of medical probability that on December 14th, 1979, Doctor Vollman, Doctor An-ders or anyone at Fort Logan Mental Health Center should have known that Mr. Buckmaster was likely to kill Officer Perreira or anyone else?
A. [Dr. Sundell] Oh, absolutely, there is no way they could have known that.
On redirect examination he was asked: “do you have an opinion based upon a reasonable degree of medical certainty as to the probability of Mr. Buckmaster causing harm to others in the future?” He replied: “Based upon the deteriorating condition of his mental illness, the absence of antipsy-chotic medication, it was foreseeable that some harm would occur.”
Much significance is placed on Buckmas-ter’s possession of a gun. It is undisputed, however, that Buckmaster had possessed this gun from 1975 until 1979, and that he told Dr. Vollman he had never used it. Buckmaster’s explanation was that he kept the gun with him because he feared for his safety when he was living in and sleeping in his car.
In the absence of a known violent propensity, I cannot agree that under these circumstances a gravely disabled patient— one who was involuntarily committed because he was unable to care for himself, not because he was dangerous to himself or others — can be considered to have presented a foreseeable risk of danger to others four months after his release from commitment.3 The majority premises its analysis on Buckmaster’s imminent danger to others as a result of his mental illness.4 At 1215-1216. I disagree with this premise, as the short-term certification in question was based on the psychiatrist’s determination that Buckmaster was gravely disabled, not that he presented an imminent danger to himself or to others. I cannot agree that the classification of Buckmaster as “gravely disabled,” as opposed to dangerous to himself or others, is without meaning. If that were so, the classification scheme of Colorado’s mental health statutes would likewise be meaningless. See §§ 27-10-102(5)5 & -107(l)(a), 11 C.R. S. (1982).
Liability for negligent release has generally been found to apply in other jurisdic*1226tions under different factual situations. A case in which a psychiatrist performs an evaluation of a patient and exercises his or her professional judgment, for example, should be distinguished from a case in which “there was a failure to evaluate the condition of potentially dangerous patients before discharging them from the hospital.” Littleton, 39 Ohio St. at 96, 529 N.E.2d at 458. Negligent release may also occur when “there was a failure to keep detailed and proper medical notes and, consequently, it could not be established whether any evaluation of the patient’s suicidal propensities had been made by a qualified psychiatrist.” Id. (emphasis added).
B. Other Factors
Other factors which are appropriate for consideration of whether a legal duty arises are “ ‘the risk involved, the foreseeability and likelihood of injury as weighed against the social utility of the [defendant’s] conduct, the magnitude of the burden of guarding against injury or harm, and the consequences of placing the burden upon the [defendant].’ ” Taco Bell, 744 P.2d at 46 (quoting Smith v. City & County of Denver, 726 P.2d 1125, 1127 (Colo.1986)). Many policy considerations are presented here. It has been argued that “the imposition of a broad duty upon psychotherapists would severely hinder the practice of mental health treatment.” Brady v. Hopper, 570 F.Supp. 1333, 1337 (D.Colo.1983), aff'd, 751 F.2d 329 (10th Cir. 1984). The rule proposed by the majority “would closely approximate a strict liability standard of care, and therapists would be potentially liable for all harm inflicted by persons presently or formerly under psychiatric treatment.” Id. at 1339. Imposing this duty to warn on psychiatrists “arguably will make ‘treatment of dangerous patients more difficult, thereby increasing the risk of violence in our society.’ ” Kalli-anos, Psychiatrists’ Liability to Third Parties for Harmful Acts Committed by Dangerous Patients, 64 N.C.L.Rev. 1534, 1545 (1986) (quoting Note, Psychiatrists’ Duty to Protect Foreseeably Endangered Third Parties—Petersen v. State, 100 Wash.2d 421, 671 P.2d 230 (1983), 18 Suffolk U.L.Rev. 879, 883 (1984)).
A seemingly irreconcilable conflict arises when one attempts to balance the express policy of Colorado’s mental health statutes favoring release of mental patients, section 27-10-101, 11 C.R.S. (1982 & 1988 Supp.), and the seemingly unlimited potential liability now imposed on mental health professionals by the majority when a professional judgment call is made permitting release of a patient. See Brady, 570 F.Supp. at 1337 & n. 4. “If a psychiatrist knows that he will face liability for failing to foresee a patient’s future violent behavior, the predictable result will be a court-mandated end to ‘out-patient’ treatment, and the massive confinement of all patients who display even a remote possibility of violent behavior.” Littleton v. Good Samaritan Hosp. & Health Center, 39 Ohio St.3d 86, 94, 529 N.E.2d 449, 456-57 (1988) (footnote omitted).
As an alternative to the malpractice standard of ordinary care and the “professional judgment standard,” see Bell v. New York City Health & Hospitals Corp., 90 A.D.2d 270, 456 N.Y.S.2d 787 (1982), and Currie v. United States, 644 F.Supp. 1074 (M.D.N.C. 1986), aff'd on other grounds, 836 F.2d 209 (4th Cir.1987), the Ohio Supreme Court has formulated its own three-part test.
[W]e hold that a psychiatrist will not be held liable for the violent acts of a voluntarily hospitalized mental patient subsequent to the patient’s discharge if (1) the patient did not manifest violent propensities while being hospitalized and there was no reason to suspect the patient would become violent after discharge, or (2) a thorough evaluation of the patient’s propensity for violence was conducted, taking into account all relevant factors, and a good faith decision was made by the psychiatrist that the patient had no violent propensity, or (3) the patient was diagnosed as having violent propensities and, after a thorough evaluation of the severity of the propensities and a balancing of the patient’s interests and the interests of potential victims, a treatment plan was formulated *1227in good faith which included discharge of the patient.
Littleton, 39 Ohio St.3d at 99, 529 N.E.2d at 460. I believe that this test successfully accommodates the competing concerns in this area, and would adopt it as the test in Colorado.
My review of the record requires me to conclude that the facts do not support the finding of a legal duty by Dr. Anders and the State to Perreira.6 By failing to establish the existence of a such a duty, the plaintiff has not made the required showing of a prima facie case of negligence. Leake, 720 P.2d at 163. Fort Logan Mental Health Center and Dr. Anders filed motions to dismiss at the conclusion of the plaintiff’s case and at the conclusion of all the evidence, asserting that Dr. Anders had no legal duty to Perreira. The trial court denied the motions. For the reasons discussed, I would hold that the trial court erred in denying the motions to dismiss the claims against Dr. Anders and the State of Colorado. As a matter of law, the two remaining defendants did not have a duty of the type asserted by the plaintiff.
I am authorized to say that Justice ERICKSON and Justice ROVIRA join in this dissent.

. I disagree with the majority’s finding that Dr. Anders had a duty and breached that duty. Even if there was a duty, however, I cannot agree with the implicit conclusion that there was a causal relationship between Buckmaster’s release on December 11, 1979, and his violent act on April 1, 1980. Even if Dr. Anders had not permitted Buckmaster's release from the facility in December 1979, Buckmaster’s short-term involuntary commitment would have expired on January 18, 1979, two and one-half months before Officer Ferreira was killed.

. Dr. Vollman explained that she “was basically referring to medications."

. The "specific threats to specific victims" limitation has been applied by some jurisdictions in failure to warn cases, and serves to protect the public or members of the public when protection is appropriate under the circumstances. See Thompson v. County of Alameda, 27 Cal.3d 741, 167 Cal.Rptr. 70, 614 P.2d 728 (1980). See generally Annotation, Liability of Governmental Officer or Entity for Failure to Warn or Notify of Release of Potentially Dangerous Individual from Custody, 12 A.L.R.4th 722 (1982).

. Mental health professionals never disputed that Buckmaster was mentally ill. At some points in time his mental illness was described as being in remission, while at other times he was "gravely disabled" and unable to care for himself.

.The statute provides this definition.
"Gravely disabled” means a condition in which a person, as a result of mental illness, is unable to take care of his basic personal needs or is making irrational or grossly irresponsible decisions concerning his person and lacks the capacity to understand this is so. A person of any age may be "gravely disabled" under this definition, but the term does not include mentally retarded persons by reason of such retardation alone.
§ 27-10-102(5), 11 C.R.S. (1982).

. Other jurisdictions have taken an even more extreme position in protecting professional judgment decisions made in the mental health area. Similar facts were presented in Sherrill v. Wilson, 653 S.W.2d 661 (Mo.1983), where an involuntarily committed patient was permitted to leave the facility on a two-day pass; during that time, he shot a person eleven times with rifle. The Missouri Supreme Court held:
[T]he defendant physicians should not be held liable for even foreseeable civil damages simply because they might be found to have exercised negligent professional judgment in permitting him to leave the premises. The decision to hold a person against his will is a very serious one, especially when the detainee has not been convicted of a crime. We believe that an "actual holding of liability would have worse consequences than the possibility of actual mistake.”
Sherrill, 653 S.W.2d at 667 (emphasis added) (quoting 2 F. Harper & F. James, The Law of Torts § 29.10 (1956).