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Emergency providers not liable for patient’s violence

Emergency healthcare providers who choose not to temporarily detain a person under the involuntary treatment act to be evaluated for commitment are not liable when the released patient harms a third party, the Court of Appeals held in Konicke v. Evergreen Emergency Servs., P.S., No. 80463-4-I (2021).

In that case, parents found themselves dealing with an adult son whose behavior had become increasingly bizarre in the course of the year after his marriage ended. He was sometimes violent, and once attacked his mother. He was living with his brother, whose alarm at a course of events over two days prompted him to call the police, and an ambulance took him to the emergency room.

Emergency room staff heard the report of the events leading up to calling the police, then evaluated the patient. Under RCW 71.05.050(3), the providers had the option to detain him and call in a designated mental health professional to evaluate him for involuntary treatment. They did not exercise this option, and he was released a few hours later.

The next day, he killed his mother, attacked his father, and set the family home on fire.

On behalf of himself and his wife’s estate, the father filed a lawsuit against the hospital and the emergency staff, asserting gross negligence in violation of chapter 71.05 RCW. The trial court granted the providers’ and hospital’s motion to dismiss. On appeal, the father advanced two theories of liability.

His first theory was that a special relationship was formed between the emergency room staff and his son when he was treated for a mental health crisis. This special relationship gave rise to the providers’ duty to protect others from the son’s harmful conduct.

The general rule is that a provider cannot be liable for medical malpractice to anyone other than a patient. But under Washington common law, a non-patient may bring a medical negligence claim under certain circumstances. When a special relationship arises between a medical provider and patient, it may trigger the provider’s duty to protect non-patients against danger caused by the patient.

The father conceded that one visit to the emergency room did not create the “definite, established, and continuing relationship” necessary under existing law to trigger a medical provider’s duty to a non-patient. He argued, however, that liability should be extended to these facts for the same policy reasons that the rule already exists, such as the provider’s ability to recognize the potential for harm and to control the patient, as well as the public's interest in safety from violent assault. The Court of Appeals rejected this bid to extend liability, pointing out the provider’s level of control is not part of the special relationship analysis, whereas foreseeability is. It affirmed the trial court’s dismissal of the medical negligence claim.

The father’s second theory was that the involuntary treatment act creates a cause of action against a provider. He asserted the language of the statute gives rise to a healthcare provider’s independent duty to protect third parties from mentally ill patients. The statute says a provider is not liable for decisions under the act if such actions are not grossly negligent. The father urged that this means a provider faces liability if a plaintiff can prove gross negligence.

The Court of Appeals disagreed. It engaged in the three-factor analysis of whether a statute gives rise to a civil cause of action. First, it examined the class of persons for whose benefit the statute was enacted. The statutory language shows the legislature intended to protect people suffering from serious behavioral health disorders, including protecting them from inappropriate involuntary commitment. Although the statute does mention protecting public safety also, the court found the specific references to the patients compelling.

Second, the Court of Appeals analyzed whether legislative intent, explicitly or implicitly, supports creating or denying a remedy. The involuntary treatment act gives providers the option to detain a patient who meets particular criteria; it does not require them to do so. That is, the provider does not have an affirmative duty to act, so it makes sense not to allow a cause of action against the provider for declining to act.

Finally, the court evaluated whether implying a remedy is consistent with the underlying purpose of the legislation. The statute limits liability for providers making determinations about whether to detain a patient. Expanding that liability, even though it could protect the public, does not fit with the overall statutory purpose. Further, interpreting the statute to permit a non-patient harmed by a released patient to bring a cause of action against the provider could prompt providers to detain patients to avoid liability, which runs counter to the expressed purpose of protecting patients from unwarranted detention.

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