Negligence

California Appeals Court Holds Psychiatrists That Released Uninsured Mentally Unstable Patient That Later Killed Woman Were Liable For Injuries Caused By Patient

The California Court of Appeal held that psychiatrists who released an involuntarily committed patient because he had no insurance were liable when the patient then committed murder.

On January 7, 2001, Joshua Daniel Lee was involuntarily admitted to Catholic Healthcare West d/b/a Robert Kennedy Medical Center (medical center) for a seventy-two-hour evaluation. Lee was treated by Dr. Juden Valdez and Dr. Viguen Movsesian (defendants), who provided treatment pursuant to CAL. WELF. & INST. CODE § 5150. Victoria Ainsworth, Lee's mother, had informed the medical center staff that Lee was threatening to commit suicide and harm others. The medical center staff determined Lee was a danger to himself and others based on the threats. On January 9, defendants determined Lee was still a threat to himself and certified him for an additional fourteen days of treatment pursuant to § 5250. During treatment, Lee was given several antipsychotic medications as prescribed by defendants. On January 10, Lee was discharged because he did not have medical insurance. On January 29, Lee kidnapped and killed Diane Bragg, and was arrested for the murder the same day. A few days later, while being detained in jail, Lee killed himself.

Bragg's children (plaintiffs) sued defendants for the wrongful death of their mother. The complaint alleged defendants knew Lee was a danger to himself and others, that they did not warn Lee of the effects of the medication he was given and that he had to keep taking it, and that they failed to warn anyone about the danger Lee posed when they released him. Defendants demurred to the complaint and claimed they did not have a doctor-patient relationship with Bragg, and thus did not owe her any duty of care. Plaintiffs opposed the demurrer by arguing their complaint was based on the failure to warn Lee about the effects of the medication and their failure to keep control of Lee. The trial court sustained the demurrer on the grounds plaintiffs failed to state a cause of action for negligence under Tarasoff v. Regents of Univ. of Cal., 17 Cal.3d 425 (1976), and defendants were immune from liability under CAL. CIV. CODE § 43.92. Plaintiffs appealed.

The California Court of Appeal, Second Appellate District, reversed the trial court's judgment. The Lanterman-Petris-Short Act (LPS Act) provides that anyone that is involuntarily institutionalized must be detained incrementally to prevent the long term commitment of a person without a proper evaluation. The LPS Act provides for the initial seventy-two-hour detention, and an additional fourteen-day commitment if the detained person is found to need additional intensive treatment. Because of the uncertainties in dealing with mentally unstable people, the LPS Act exempted certain people from civil or criminal liability in connection with the provision of treatment. However, there may be a duty of care that is owed if a third-party is injured by a committed person who was released for improper reasons, and therefore the immunity issue depends on a determination of whether a duty exists. To determine whether a duty is owed requires a balancing of the forseeability of the harm and the burden on the defendants to exercise care. In this case, said the appeals court, it was foreseeable that Lee would be a danger to the community if he were released without the proper treatment. The only reason defendants gave for releasing Lee was that he did not have insurance, said the court; however, defendants were required to make a judgment based on medical and not financial reasons. Therefore, the appeals court determined defendants owed a duty of care to the community and that they had breached that duty.

The appeals court then addressed the issue of immunity, and found it did not apply to the facts in this case. Pursuant to §§ 5154 and 5259.3 the decision to release a person who is committed can only be made after it is determined that the person is no longer a danger to the community. The appeals court concluded that the decision to release would have to be made based on good faith and the allegation that defendants made the decision to release based on monetary reasons would bar the application of immunity.

The trial court erred in applying Tarasoff to this case, said the appeals court, because the plaintiffs' argument was not based on the failure to warn potential victims, but the release of Lee for monetary reasons. The appeals court also held that immunity under § 43.92 did not apply to determine if immunity under that section applied, and held that it did not because the section provides there is no duty to warn unless the patient makes a specific threat. In this case, the claim was about the failure to make a good faith judgment for release and not about the failure to warn. The appeals court also rejected Movsesian's argument that there was no causal connection between defendants' actions and Lee's murder of Bragg because it was too early in the litigation to make a preliminary determination of causation. Therefore, the appeals court reversed the trial court's judgment.

To read Bragg v. Valdez, No. B158819 (Cal. Ct. App. Aug. 18, 2003), click here