Judge Carmen D. Minora of the Lackawanna Court Court of Common Pleas ruled that a wife held hostage by her ex-husband was permitted to sue her ex-husband’s psychiatrist under the Pennsylvania Mental Health Procedures Act (MHPA), thereby denying the defendant psychiatrist’s motion for summary judgment (Rarrick v. Silbert, 2002 CV 4951 (C.P. Lackawanna County Mar. 25, 2015). The court found there was a question of fact as to whether the defendant psychiatrist’s actions constitute gross negligence under the MHPA.
The plaintiff (ex-wife) instituted the medical malpractice action against the defendants, including her ex-husband’s psychiatrist and a behavioral health facility. Before her planned move out of the family home (due to what the Court characterized as “the rapid decline in marital and familial harmony resulting from her former husband’s deteriorated mental state”), she called the doctor on “multiple occasions” regarding her concerns about her former husband’s condition. She reported he “referenced ‘guns and killing’” and specifically threatened her. In addition, the man’s father called the doctor to alert him to the change in behavior. The day after the calls, the plaintiff was held at gunpoint by her former husband. Later, the father was taken hostage when he arrived at the house. Ultimately, the police negotiated with the former husband and took him into custody.
The doctor filed a Motion for Summary Judgment, arguing Pennsylvania law does not recognize a duty owed by psychiatrists to protect unidentified third parties from the actions of mental health patients. He also argued he was entitled to summary judgment since the former wife was unable to meet the heightened burden of proof of gross negligence, imposed by the MHPA. The court agreed with the doctor on the first point, noting that under Pennsylvania common law, there exists only a narrow duty owed by a psychiatrist to protect third parties against dangers posed by their mental health patient. Specifically, “a duty to warn in this context exists only where a specific and immediate threat of serious bodily injury has been conveyed by the patient to the professional regarding a specifically identified or readily identifiable victim.”
Although the Court agreed with the doctor that no duty to warn was owed to the plaintiff, the Court denied Motion for Summary Judgment, relying on the MHPA. Judge Minora held that a reasonable jury could find the doctor’s actions constituted gross negligence under the MHPA, which the Court examined separately from the common law duty to warn. The Court stated the MHPA “provides that no physician shall be held civilly or criminally liable absent willful misconduct or gross negligence,” defined as “negligence where the facts support substantially more than ordinary carelessness, inadvertence, laxity or indifference.” In support of this conclusion, the Court cited the following: (1) The plaintiff called the doctor on multiple occasions; (2) The plaintiff called the doctor regarding her concerns of the impact of the move; (3) the man’s father separately called the doctor about his son; and (4) the doctor was aware of the man’s “fragile psychological state, coupled with his possession of guns and various hunting rifles.”
Judge Minora’s opinion does not discuss the defendant psychiatrist’s response to the former wife’s phone calls regarding her ex-husband, nor does the opinion discuss the former husband’s behavior during treatment other than to say the doctor was aware of the man’s “fragile psychological state, coupled with his possession of guns and various hunting rifles.”
Finally, the doctor argued that summary judgment was in order, since the former wife failed to produce an expert report critical of the defendant psychiatrist. The Court held Summary Judgment was inappropriate because the defendants failed to pursue the remedies available under Pa. R.C.P. 1042.31(a), including sanctions, for the plaintiff’s failure to produce reports.
The doctor filed a Motion for Reconsideration of the Court’s denial of his Motion for Summary Judgment, which was denied. The Court rejected the doctor’s argument that since the Court previously held there was no common law duty owed by the doctor to the plaintiff, there could be no valid claim. Judge Minora explained that the previous decision was based upon the MHPA, which allows a physician to be held liable for gross negligence.
Comment: Although Rarrick v. Silbert declined to broaden a psychiatrist’s duty to warn third parties beyond the common law duty requiring a readily identifiable victim and specific threat of imminent harm, the Court cited the MHPA as a separate basis to hold the defendant psychiatrist liable. The Court’s distinction between a common law duty and a separate statutory duty under the MHPA warrants attention from psychiatrists when treating potentially dangerous patients in an inpatient setting. The key decisions would pertain to the decision of whether to admit the patient, whether to discharge the patient, and whether to recommend the patient for a lower level of care, such as partial hospitalization.
It is unclear from the opinion in Rarrick whether the doctor was treating the patient in an inpatient or outpatient setting. Under Pennsylvania law, courts have applied different duties of care for inpatient versus outpatient mental health treatment. Where a patient is being treated by a mental health provider in an inpatient context, the MHPA requires that a plaintiff prove the defendant’s actions in deciding “that a person be examined or treated …or that a person be discharged or placed on a partial hospitalization, outpatient care, or leave of absence” constituted gross negligence or willful misconduct.” 50 P.S. § 7101, et seq. Assuming the doctor treated the patient in an inpatient setting and inappropriately discharged him from inpatient care, the gross negligence standard would apply and the doctor could not be found liable absent gross negligence or willful misconduct. The significance of Rarrick may lie in the fact that the Court found the defendant psychiatrist’s conduct may constitute gross negligence where the plaintiff contacted the doctor regarding her ex-husband’s erratic and threatening behavior and was aware of his “fragile psychological state, coupled with his possession of guns and various hunting rifles.”
For more information, please contact Noah E. Katz at nkatz@wglaw.com or 570.961.2706