The Massschusetts Supreme Judicial Court decided in its August 14, 2018 opinion, in a psychiatric malpractice case in which the plaintiffs alleged that by releasing a patient eleven days after his commitment when there was a likelihood of serious harm to all persons who came in contact with him that the hospital violated a nondelegable duty of care, that the clinical determination to release “N” was made, and could only have been made, by an individual mental health professional, here, his treating physician, and that any duty involving the release of “N,” and any negligence in authorizing his release under the terms of the order of commitment, belonged to this treating clinician, who was required to use professional medical judgment in determining that commitment was required and when it was no longer needed.
The Massachusetts Supreme Judicial Court stated that the Massachusetts Legislature has determined that a qualified mental health professional may make a clinical determination to release a psychiatric patient, consistent with the highest possible standards of professional treatment, without notifying the court that issued the order of commitment, because a clinician is in the best position to determine whether a patient no longer poses a threat of serious harm. The Massachusetts Legislature chose not to impose a separate duty on a hospital, and not to delay the release of a patient that the hospital no longer has a legal right to confine. Continuing to hold a patient where a mental health professional has determined that there is no threat of serious harm would result in a violation of the patient’s constitutional liberty interest and would be a violation of G. L. c. 123, §§ 7 and 8. Consistent with its view of medical and legal standards, the Massachusetts Legislature left such determinations to qualified mental health professionals.
The Massachusetts Supreme Judicial Court stated that the same standard of serious harm guides mental health care professionals’ responsibility to report; foreseeability of harm to the plaintiff is one of the major considerations in determining if a mental health professional has a duty to warn a potential victim.
General Laws c. 123, § 36B, defines an individual mental health professional’s narrow duty to warn in the Commonwealth. In balancing a patient’s right to privacy with public safety, the statute strongly favors a patient’s right to privacy, as is evident in the narrowness of the duty to warn. The right to be free from physical restraint is at least as fundamental as a patient’s right to privacy. The Massachusetts Supreme Judicial Court held: “We are reluctant to disrupt the Legislature’s careful balancing and to impose a duty on hospitals, which do not make individual clinical judgments, where the Legislative mandate and constitutional protections counsel against doing so.”
However, a hospital is not necessarily free from all liability arising out of a clinical determination that a patient no longer presents an imminent risk of serious bodily harm due to mental illness. A hospital may be liable under a theory of respondeat superior, arising out of an employment relationship, for the actions of its medical professionals. In addition, a hospital owes third parties a duty of reasonable care in hiring, training, and supervising the medical professionals who care for its patients.
The Massachusetts Supreme Judicial Court stated that had a claim been made against any of the individual mental health care professionals involved in “N”‘s care, the immunity provisions of G. L. c. 123, § 36B (1), would have been applicable to them, and the professionals involved almost certainly would have had individual immunity. Although the Massachusetts Supreme Judicial Court stated that it need not decide whether an exception applied in this case, in order for the statutory exception to the immunity provisions of G. L. c. 123, § 36B (1), to apply, a patient must make a specific threat about a specific person, and must have an apparent ability and intent to carry out that threat. In the present case, there is no indication in the record that the defendant ever threatened the decedent or her family.
The Massachusetts Supreme Judicial Court stated that the language of G. L. c. 123, § 36B, that a mental health professional has no duty to warn or in any other way protect a potential victim, would prevent the imposition of a duty to control on a mental health professional and, accordingly, on a hospital under a theory of respondeat superior. However, the statute does not address the independent, common-law duty of a hospital to control a patient who has been civilly committed, and the legislative history does not suggest an intent to displace a duty owed by an institution.
Nonetheless, the Massachusetts Supreme Judicial Court stated that the hospital’s duty to control is more narrow than the plaintiffs contend. The hospital had a duty to hold “N” while he was lawfully committed to the hospital for a period not to exceed six months. The hospital’s duty of care is limited to the period of actual custody. The hospital’s duty to control “N” ceased when his treating physician reached the clinical judgment that “N” no longer presented a likelihood of serious harm by reason of mental illness, and released “N.” Under the terms of the commitment order, “N”‘s commitment to the hospital was no longer authorized once the clinical determination was made. The hospital’s act of releasing him was not merely proper, it was required by the terms of the order.
The Massachusetts Supreme Judicial Court concluded: “As the duty to hold “N” followed directly from the order of commitment, when his treating mental health professional determined that he no longer presented a likelihood of serious harm and ordered his release, the hospital no longer had actual control of “N” or the authority to hold him. In the absence of this special relationship, the hospital had no duty to hold, or otherwise to control, “N” three weeks later when he attacked the victim in her home.”
Source Williams vs. Steward Health Care System, LLC, SJC-12451.
If you or a loved one may have been harmed as a result of psychiatric malpractice in Massachusetts or in another U.S. state, you should promptly find a Massachusetts medical malpractice lawyer, or a medical malpractice lawyer in your state, who may investigate your psychiatric negligence claim for you and represent you in a psychiatric malpractice case, if appropriate.
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