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Malpractice Rx


To protect and serve: Psychiatrists’ duty to patients

Vol. 5, No. 12 / December 2006

Patient discharged from group therapy kills psychiatrist, patient, and himself

Oakland County (MI) Circuit Court

The plaintiff, age 57, attended regular group therapy with a psychiatrist. Another patient, Mr. B, was dismissed from group therapy by the psychiatrist, but returned to the office with a gun during one of the regular sessions. Mr. B shot and killed the psychiatrist then entered the group meeting room and discharged his gun, fatally injuring another patient and wounding the plaintiff. Mr. B then turned the gun on himself and committed suicide. The plaintiff suffered gunshot wounds to the lower leg, foot, and hand and was away from work for 6 weeks.

The plaintiff alleged that the psychiatrist, his associates, and his daughter—who is also a psychiatrist at the office—knew Mr. B was dangerous and should not have been included in group therapy. The plaintiff claimed that Mr. B had a history of questionable psychotic behavior and other patients should not have been exposed to him. The psychiatrist’s associates contended that they had no way to anticipate this event and had used due care and caution in their practice.

  • A $2 million verdict was returned

Dr. Grant’s observations

Warn and protect

In this case, several unavailable facts may have supported the successful negligence claim. For example, why was Mr. B dismissed from the group? Did he threaten someone in the group? Did he tell the group or the group leader about thoughts of violence or homicide? If so, perhaps a violent event was foreseeable.

Was Mr. B dismissed because of delusional or paranoid thoughts? What was done to help him, and were appropriate referrals in place? Instituting the right interventions requires clinicians to walk a fine line between preserving doctor-patient confidentiality and protecting other patients and the general public.

Doctor-patient confidentiality is deeply rooted in medical ethics and protected by law—in various forms—in all jurisdictions. Directives requiring a physician to reveal information without a patient’s consent are either legislated—and tend to be clear—or are based on court precedent, which is more open to interpretation. These mandated exceptions are purpose-specific and intended to preserve overall doctor-patient confidentiality.“Is this patient dangerous?” by John Battaglia, MD, and “Protect yourself from patient assault”, an interview between Dr. Battaglia and Lois E. Krahn, MD.

References

1. Kleinman I. Confidentiality and the duty to warn. Can Med Assoc J 1993;149:1783-5.

2. Chaimowitx G, Glancy G. The duty to protect. Can J Psychiatry 2002;47:1-4.

3. Tarasoff v. Regents of the University of California, 118 Cal. Rptr. 129 (Cal. 1974) (Tarasoff I), modified by Tarasoff v. Regents of the Univ. of Cal., 551 P.2d 334 (Cal. 1976) (Tarasoff II).

4. Naidu v. Laird, 539 A.2d 1064 (Del. 1988).

5. Davis v. Lhim, 335 N.W.2d 481 (Mich. App. 1983).

6. Beck J, Baxter P. The violent patient. In: Lifson LE, Simon RI, eds. The mental health practitioner and the law. Cambridge, MA: Harvard University Press; 1998:153-65.

7. Buckner F, Firestone M. Where the public peril begins: 25 years after Tarasoff. J Legal Med 2000;21:187-222.

8. Corey G, Williams GT, Moline ME. Ethical and legal issues in group counseling. Ethics & Behavior 1995;5:161-83.

9. American Counseling Association code of ethics and standards of practice 2005. Available at: http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx. Accessed October 23, 2006.

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