§47.20 Duty of Psychiatrist to Prevent Injury by Patients to Others

The Case:  Turner v. Jordan, 957 S.W.2d 815 (Tenn. 1997).

The Basic Facts:  Plaintiff, a nurse at a hospital, was attacked by a mentally ill patient.  Plaintiff brought a medical malpractice suit against the mentally ill patient’s physician, alleging the doctor failed to use reasonable care in treating the patient.

The Bottom Line:

• “Although we have generally held that a person has a duty to use reasonable care to refrain from conduct that will foreseeably cause injury to others, Doe v. Linder Construction Co., 845 S.W.2d 173, 178 (Tenn. 1992), this duty does not extend to the protection of others from the dangerous conduct of third persons unless the defendant ‘stands in some special relationship to either the person who is the source of the danger, or to the person who is foreseeably at risk from the danger.’  Bradshaw, 854 S.W.2d at 871, citing, [Restatement (Second) of Torts § 315 (1964)].  As we said in Bradshaw, ‘while an actor is always bound to prevent his acts from creating an unreasonable risk to others, he is under the affirmative duty to act to prevent another from sustaining harm only when certain socially recognized relations exist which constitute the basis for such legal duty.’  [854 S.W.2d at 871 (quoting Harper & Kime, The Duty to Control the Conduct of Another, 43 Yale L.J. 886, 887 (1934)].”  957 S.W.2d at 818.

• “As the Court of Appeals observed, the Tarasoff cases, like our decision in Bradshaw, supra, emphasized the presence of a special relationship, that is, the psychiatrist/patient relationship.  The cases further consider the factors we have typically balanced in determining whether a duty exists: the foreseeability and severity of potential harm; the nature of the defendant’s conduct; and the availability, safety and effectiveness of alternatives.  See McCall, 913 S.W.2d at 153.”  Id. at 820.

• “Applying these factors, we agree that Dr. Jordan, as Williams’s attending psychiatrist, owed a duty of care to the plaintiff, a nurse on the psychiatric unit.  He knew of Williams’s prior violent conduct while hospitalized, including one occasion in which Williams attacked a member of the hospital staff (indeed, Jordan himself).  Dr. Jordan was also well aware of Williams’s present dangerousness-- he described Williams as ‘aggressive, grandiose, intimidating, combative, and dangerous.’  Although this unreasonable risk of harm was reasonably apparent, Dr. Jordan, who had the ability to control Williams in the inpatient psychiatric ward, took no action other than to recommend Williams be encouraged to request discharge against medical advice.  Although the defendant now contends that he had no control over Williams and that he was obligated to apply the least restrictive means of treatment, the record indicates that he never considered other reasonable measures to prevent the risk Williams posed to other patients, staff members, or other readily identifiable foreseeable victims.”  Id.

• “We stress that we are not requiring psychiatrists or physicians to possess perfect judgment or a degree of clairvoyance in determining whether a patient poses a risk of harm to a third person.  Instead, we merely hold that a duty of care may exist where a psychiatrist, in accordance with professional standards, knows or reasonably should know that a patient poses an unreasonable risk of harm to a foreseeable, readily identifiable third person.  The courts below correctly held that the facts in this case met this standard.”  Id. at 820-21.

Other Sources of Note:  White v. Lawrence, 975 S.W.2d 525, (Tenn. 1998); Conley v. State, 141 S.W.3d 591 (Tenn. 2004) (distinguishing Turner and holding it inapplicable where personal representative of a nursing home patient who was beat to death by another patient brought suit against the State, asserting that it was negligent in the pre-admission screening of attacking patient).