In its opinion filed on June 29, 2018, the Pennsylvania Superior Court (“Pennsylvania Appellate Court”) ruled that the lower court had properly allowed the wrongful death claim against the defendant mental health professionals to proceed where a homicidal and suicidal mental health patient under their outpatient care killed his neighbor.
Duty To Warn
Pennsylvania law only imposes a duty on mental health professionals to warn third parties of the danger posed by a mental health patient in limited circumstances. Specifically, the duty arises where:
(1) a special relationship exists between the mental health professional and the patient;
(2) the patient has communicated to the mental health professional a specific and immediate threat of serious bodily injury;
(3) the patient’s threat is against a specifically identified or readily identifiable third party; and
(4) the mental health professional determines, or should determine, that the patient presents a serious danger of
violence to the third party.
In the case the Pennsylvania Appellate Court was deciding, it was the third prong that was in dispiute, i.e., whether the patient’s threat was against a specifically identified or readily identifiable third party.
The Appellate Court stated that while there is generally no duty to control the conduct of a third party, where the defendant stands in a special relationship to the victim or some other party, the victim deserves protection. That special relationship between the mental health professional and the patient is the basis for an exception and imposition of an affirmative duty to warn. In addition, the special relationship between a mental health provider and an outpatient, in addition to serving as a foundation for a duty to warn a third party, may support a broader duty to protect or commit to inpatient treatment.
The duty to warn arises when a mental health professional determines that his patient has communicated to the professional a specific and immediate threat of serious bodily injury against a specifically identified or readily identifiable third party and when the professional determines, or should determine under the standards of the mental health profession, that his patient presents a serious danger of violence to the third party.
A mental health professional has a duty to exercise reasonable care to protect by warning a third party of the danger posed by a patient. That would include the situation where a patient communicated an immediate, known and serious risk of potentially lethal harm regarding a specially identified or readily identifiable victim.
In the case the Pennsylvania Appellate Court was deciding, the mental health patient did not verbalize a specific threat against the victim or any other named individual; however, he communicated to the mental health defendants his intent to kill his neighbor and his next-door neighbor. He had a plan and he was going to use scissors to stab his neighbor. Shortly before he killed his neighbor by stabbing her with scissors, he told the defendants that he was carrying scissors on his person for that purpose.
The Pennsylvania Appellate Court held that the duty to warn exists where the target is identifiable, not just identified by name, and that mental health professionals must use reasonable efforts to identify the victim. Thus, to the extent that the defendants contend that the intended target must be named, the Pennsylvania Appellate Court rejected that position.
The Pennsylvania Appellate Court further held that the duty to warn was not limited to one individual. The duty to warn may be extend to individuals who are readily identifiable because they are members of a group.
In the case it was deciding, the Pennsylvania Appellate Court stated that the threat was directed at a member of a small, distinct, and identifiable group – the fourth floor tenants of the apartment building who were the patient’s neighbors. The defendants knew where the patient lived (they assisted him in securing his apartment). Practically speaking, the identities of the patient’s fourth floor neighbors could be readily ascertained from the building management in order to communicate a reasonable warning and, alternatively, the proximity of their apartments to the patient’s apartment made it possible to warn these individuals even without knowing their names. Moreover, the group was small enough that a reasonable warning would not produce a cacophony of warnings by their volume.
The Pennsylvania Appellate Court held that the record amply demonstrates that the patient’s threats of serious bodily injury were specific, and immediate, and communicated to the defendants, and agreed with the trial court that the plaintiff made the requisite prima facie showing of a duty. The remaining questions as to whether the defendants breached that duty, whether their conduct fell below the standard of care, and if so, whether it was a cause in fact of the victim’s death, are questions of fact for the jury.
Source Maas v. UPMC Presbyterian Shadyside D/B/A Western Psychiatric Institute and Clinic, 2018 Pa Super 195.
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