Imposing Broad Liability for Duty to Warn Risks Patient Care, APA Says

If physicians are exposed to potentially catastrophic liability for treating patients with conditions that may be associated with any appreciable risk of violence, they are liable to be strongly disincentivized from treating those individuals.

That’s what APA asserts in an amicus curiae brief filed with the Pennsylvania State Supreme Court in a case involving a plaintiff seeking compensatory damages from a psychiatrist to cover legal and other costs related to crimes committed by the plaintiff’s family member while undergoing psychiatric treatment. The case is Sandra Dinardo v. Christian Kohler, M.D., Hospital of the University of Pennsylvania, University of Pennsylvania Health System, and Trustees of the University of Pennsylvania.

A ruling is expected early this year.

“If you make it possible for high-risk patients to seek damages from a psychiatrist when patients commit a violent crime, then no psychiatrist is going to treat patients at risk of violence,” said Reena Kapoor, M.D., chair of APA’s Committee on Judicial Action. “We want high-risk patients to receive treatment.”

The lawsuit was initiated against Christian Kohler, M.D., the Hospital of the University of Pennsylvania, University of Pennsylvania Health System, and trustees of the University of Pennsylvania by Sandra DiNardo. She is the mother of Cosmo DiNardo, who murdered four people between July 5 and 7, 2017, in Bucks County, Pa. The lawsuit seeks recovery for Cosmo’s legal fees in defending the criminal charges against him; indemnification for payments made to settle civil lawsuits being pursued by the families of the victims; and recovery for Cosmo’s own emotional distress resulting from incarceration, based on the contention that he committed the crimes as a result of Kohler’s alleged negligent psychiatric care.

APA’s amicus asserts that psychiatrists do not owe a duty to protect third parties except in extremely narrow circumstances and that granting a plaintiff’s complaint for indemnification in such a case would expand psychiatrists’ liability in ways that would harm patients and the general public.

The brief cites a 1998 ruling, Emerich v. Philadelphia Center for Human Development Inc., by the Pennsylvania Supreme Court limiting a psychiatrist’s duty to warn that a patient might pose a danger to third parties. “While this Court did not categorically reject the existence of such a duty, it recognized that any such duty is ‘extremely limited’—that is, it exists only when a patient makes a ‘specific and immediate threat’ against ‘a specifically identified or readily identifiable victim.’ The Court’s decision was rooted in the recognition that imposing any less restrictive limits on the liability of psychiatrists and other mental health care providers could undermine patients’ access to and the effectiveness of psychiatric treatment—which would in turn harm both patients and the public.”

The brief also cites a 2020 case, Leight v. Univ. of Pittsburgh Physicians, in which the state Supreme Court again declined to broaden psychiatrists’ duties to third parties, finding that such duties would likely discourage physicians from treating certain patients.

Further, the APA brief notes that the state Supreme Court has consistently barred courts from imposing on psychiatrists a general duty to third parties because doing so would harm psychiatric patients. “The strict limitations this Court has established on mental health care providers’ duties to third parties reflect urgent concerns that expansive liability would impair patients’ access to psychiatric care. This Court has repeatedly warned that imposing on psychiatrists a general duty to third parties will undermine the trust between patient and psychiatrist; result in at least some psychiatrists refusing to treat certain patients; and undermine insurance markets. Moreover, by imposing liability ex post, such a rule ignores the fact that it is extraordinarily difficult for physicians to predict whether a patient will, in fact, commit an act of violence.” ■