McIntosh v. Milano
168 N.J. Super. 466, 403 A.2d 500 (1979)
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Rule of Law:
A psychiatrist or therapist has a duty to take whatever steps are reasonably necessary to protect an intended or potential victim of their patient when they determine, or should determine according to professional standards, that the patient presents a probability of danger to that person.
Facts:
- On May 5, 1973, Dr. Michael Milano, a board-certified psychiatrist, began treating 15-year-old Lee Morgenstein for an adjustment reaction of adolescence and drug involvement.
- During therapy over the next two years, Morgenstein related fantasies of fear, being a villain, and using a knife to threaten people, as well as alleged experiences and emotional involvements with his neighbor, Kimberly McIntosh.
- Dr. Milano learned that Morgenstein had fired a BB gun at McIntosh's car on one occasion when upset, and that Morgenstein had purchased and carried a knife to therapy to show the doctor, stating he intended to use it to scare people.
- Although Dr. Milano had spoken to Morgenstein's parents about issues, including the relationship with McIntosh, in late 1974 and 1975, he never attempted to contact Kimberly McIntosh or her parents.
- On July 8, 1975, Morgenstein stole a prescription form from Dr. Milano's desk during a therapy session and later attempted to fill it for Seconal tablets at a pharmacy.
- The pharmacist, suspicious, called Dr. Milano, who instructed him not to fill the unauthorized prescription and to send Morgenstein home.
- Later that evening, after leaving the pharmacy upset, Morgenstein obtained a hidden pistol, waited for Kimberly McIntosh to visit her parents, and fatally shot her in a local park area.
Procedural Posture:
- Peggy McIntosh, as administratrix of Kimberly A. McIntosh's estate, filed a wrongful death action against Dr. Michael Milano in the Superior Court of New Jersey, Law Division.
- Defendant Dr. Milano filed a motion for summary judgment, seeking to dismiss the complaint on the grounds that he owed no duty to Kimberly McIntosh.
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Issue:
Does a psychiatrist or therapist in New Jersey have a legal duty to warn or protect a third party from a patient's dangerous propensities?
Opinions:
Majority - Petrella, J.S.C.
Yes, a psychiatrist or therapist in New Jersey may have a duty to take reasonably necessary steps to protect an intended or potential victim of their patient. The court held that such a duty arises when the therapist determines, or pursuant to the standards of his profession should determine, that the patient presents a probability of danger to a specific person. This principle, analogous to the California Supreme Court's decision in Tarasoff v. Regents of Univ. of California, is grounded in the weighing of the relationship of the parties, the nature of the risk involved, and the public interest in imposing such a duty. The court rejected arguments that psychiatrists cannot accurately predict dangerousness, noting that their profession already involves diagnoses and prognoses based on patient history, and that such an inability would undermine current civil commitment procedures. Furthermore, patient confidentiality is not absolute; ethical principles and existing law (e.g., duty to warn of contagious diseases, reporting crimes) support disclosure when necessary to protect the welfare of an individual or the community. The court concluded that preventing frivolous suits should not eliminate a cause of action for aggrieved individuals against a class of professionals, and a jury should determine if Dr. Milano breached the appropriate duty based on expert testimony and the facts presented.
Analysis:
This case is significant for extending the common law duty of care for mental health professionals in New Jersey, establishing that a therapist's obligation extends beyond the patient to identifiable third parties who face a foreseeable risk of harm. By adopting the Tarasoff principle, it underscored a public policy prioritizing public safety over absolute patient confidentiality in serious circumstances. The decision necessitates that therapists actively assess and, when appropriate, act to mitigate threats posed by their patients, potentially influencing how patient privacy laws are interpreted and applied in cases involving imminent danger and raising complex ethical considerations for the profession.
