Estates of Morgan v. Fairfield Family Counseling Center
673 N.E.2d 1311, 77 Ohio St. 3d 284 (1997)
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Rule of Law:
The special relationship between a psychotherapist and an outpatient imposes a duty on the psychotherapist to exercise best professional judgment to protect others when the therapist knows or should know that the patient presents a substantial risk of harm to others.
Facts:
- Matthew 'Matt' Morgan, a man diagnosed with schizophrenia, was stabilized on the antipsychotic medication Navane while under the care of a psychiatrist in Philadelphia.
- After moving to Ohio, Matt began treatment with psychiatrist Dr. Harold Brown on July 19, 1990.
- Dr. Brown received Matt's prior medical records but did not review them. Over three appointments, he diagnosed Matt as a malingerer and weaned him off Navane.
- Matt's last appointment with Dr. Brown was on October 11, 1990, after which he began receiving vocational therapy from Fairfield Family Counseling Center (FFCC).
- Over the next nine months, Matt's mental condition deteriorated; he exhibited violent outbursts, talked to himself, and put a deposit on a handgun.
- Matt's mother repeatedly contacted FFCC, expressing grave concern over his deterioration and potential for violence, and pleaded for intervention.
- On July 25, 1991, more than nine months after his last appointment with Dr. Brown, Matt shot and killed both of his parents and injured his sister.
Procedural Posture:
- The estates of the deceased victims and the injured victim (plaintiffs) filed a negligence lawsuit against Dr. Harold Brown and Fairfield Family Counseling Center (FFCC) in the Fairfield County Court of Common Pleas (trial court).
- The trial court granted summary judgment in favor of both Dr. Brown and FFCC, dismissing the case.
- The plaintiffs appealed the decision to the Court of Appeals for Fairfield County (intermediate appellate court).
- The Court of Appeals affirmed the summary judgment for FFCC but reversed the summary judgment for Dr. Brown, finding a triable issue of fact existed as to his liability.
- The case was then appealed to the Supreme Court of Ohio (highest court) for a final determination on the scope of a psychotherapist's duty.
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Issue:
Does the 'special relation' that creates a psychotherapist's duty to control a patient's violent propensities extend to the outpatient setting?
Opinions:
Majority - Resnick, J.
Yes. The relationship between a psychotherapist and an outpatient constitutes a special relation that imposes a duty upon the therapist to take steps to control the patient’s violent conduct. The court extended the duty recognized for inpatients in Littleton to the outpatient setting, reasoning that while a therapist has less control over an outpatient, sufficient elements of control (such as prescribing medication, persuading voluntary hospitalization, or initiating commitment proceedings) still exist. The appropriate standard of care is the 'psychotherapist judgment rule,' which insulates therapists from liability for simple errors in judgment but not for decisions that are not the product of a careful, thorough, and good-faith professional evaluation. The court rejected a rule requiring 'specific threats to specific victims' in cases involving a failure to control (as distinct from a failure to warn), finding that a therapist must act when a patient poses a foreseeable danger to others, even if the specific victim is not identified. The court concluded that genuine issues of material fact existed as to whether Dr. Brown (for failing to read records) and FFCC (for using unqualified staff for evaluations) exercised their best professional judgment.
Dissenting - Cook, J.
No. A 'special relation' imposing a duty to control does not generally exist in an outpatient setting because the psychotherapist lacks the requisite ability or right to control the patient's conduct. The Restatement's exceptions to the no-duty rule are based on a real ability to control, which is absent with a voluntary outpatient who can refuse treatment and medication. Dr. Brown had no control over Matt, especially nine months after their last meeting. The majority's holding creates an ambiguous and potentially limitless standard of liability for a wide range of mental health professionals, which could lead to strict liability for their patients' actions.
Dissenting - Stratton, J.
No. Extending a 'special relation' to this outpatient context imposes an impossible, perpetual duty on psychotherapists for events occurring long after treatment has ceased. The majority's opinion also incorrectly interprets the state immunity statute, R.C. 5122.34, which should protect mental health agencies like FFCC for good-faith decisions not to hospitalize a patient. By denying immunity for a decision against commitment, the court creates a perverse incentive for professionals to over-hospitalize patients to avoid liability, contrary to the modern goal of treatment in the least restrictive environment. The decision ignores the practical difficulties of predicting violence and the realities faced by underfunded mental health agencies.
Analysis:
This decision significantly expands the scope of psychotherapist liability in Ohio by extending the duty to control dangerous patients from the inpatient to the outpatient context. It establishes the 'psychotherapist judgment rule' as the governing standard of care, creating a middle ground between ordinary negligence and full immunity, which focuses on the process of the therapist's decision-making rather than the outcome. By rejecting the 'specific threats to specific victims' limitation for negligence claims based on a failure to control, the court broadens the class of potential plaintiffs to anyone within a foreseeable zone of danger. This holding will likely compel mental health professionals to be more aggressive in diagnosing, managing, and documenting the treatment of potentially violent outpatients to demonstrate that their decisions were the product of a thorough and good-faith professional judgment.
