Texas Court of Appeals Holds That a Hospital Had No Duty to Protect from Harm Three Individuals, Including an Ex-Wife, Who a Depressed, Paranoid, and Suicidal Patient Murdered after Leaving the Hospital

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The California Supreme Court in 1976 ruled that mental health providers in California must take reasonable steps when they know or should know that their client presents a serious danger of violence to an identified or readily identifiable third party. Tarasoff v. Regents of the Univ. of Cal., 551 P.2d 334 (Cal. 1976). Most states currently impose similar duties on their mental health professionals. Anthony Parsio, The Psychotherapist-Patient Privilege: The Perils of Recognizing a "Dangerous Patient" Exception in Criminal Trials, 41 NEW ENG. L. REV. 623, 642 (2007).

The Supreme Courts of both Texas and Virginia rejected this so-called Tarasoff doctrine. The Virginia Supreme Court held that neither the doctor-patient relationship nor the hospital-patient relationship, standing alone, qualified as a "special relationship" that would trump the general rule that there is no duty to control the conduct of someone to prevent harm to a third party and thereby trigger a duty to warn non-patients of a patient's threats to harm them. Nasser v. Parker, 455 S.E.2d 502 (Va. 1995). The court noted that a special relationship that would require a warning could exist if a doctor or a hospital was vested with a higher degree of control over the patient than exists in an ordinary doctor-patient or hospital-patient relationship, but this requisite degree of control was not established merely by accepting and admitting a patient for the purpose of providing continuing and prolonged mental health treatment.

Virginia did, nonetheless, adopt a modified version of the Tarasoff doctrine when it passed legislation establishing that a Virginia mental health provider must take precautions to protect third parties from violent behavior or other serious harm when a client communicates to the mental health provider a specific and immediate threat to cause serious bodily injury or death to an identified or readily identifiable person and the provider reasonably believes, or should believe according to the standards of his or her profession, that the client has the intent and ability to carry out that threat immediately or imminently. VA. CODE ANN. [section] 54.1-2400.1.

Similar to the Virginia Supreme Court, the Texas Supreme Court in Thapar v. Zezulka, 994 S.W.2d 635, 639 (Tex. 1999), held that mental health professionals were not required to disclose a patient's threats to harm others. As the rationale for its ruling, the court cited a decision by the Texas Legislature to enact a confidentiality statute three years after Tarasoff that closely guarded the communications of patients with mental-health professionals and that did not provide an exception for disclosures to third parties threatened by a patient.

Lower courts in Texas, however, have continued to wrestle with when a mental health professional or health care facility might incur liability to a third party for the actions taken by a client. The Texas Court of Appeals in Boren v. Texoma Medical Center, Inc. (2008) ruled that a hospital in the case before it had no duty to protect from harm three individuals, including an ex-wife, whom one of its patients had murdered after leaving the hospital.

This case began when a man came to the hospital's emergency room at 7 a.m. with a superficial self-inflicted knife wound to his chest. An emergency room physician examined and interviewed the man and concluded he was depressed, paranoid, and suicidal. He was then referred to the hospital's mental health department for evaluation and possible hospitalization. …