Pennsylvania Supreme Court Considers Neighbors to Be Identifiable Victims under Duty to Warn
In Maas v. UPMC Presbyterian Shadyside, 234 A.3d 427 (Pa. 2020) the Supreme Court of Pennsylvania examined the scope of the state's duty to warn in a case where a patient killed a victim in his 40-unit apartment building after making statements about wanting to kill a “neighbor.” In a trial over wrongful death, the patient's health care providers moved for summary judgment arguing that they did not have a duty to warn under Pennsylvania common law because the patient did not identify a “readily identifiable” victim. The Pennsylvania Supreme Court affirmed the lower courts' decisions not to grant it, because his threat toward a “neighbor” was specific enough to constitute a “readily identifiable” victim.
Facts of the Case
In 2008, after moving from a personal care home to an apartment building, Terrance Andrews, a patient at University of Pittsburgh Medical Center (UPMC) Western Psychiatric Institute & Clinic (WPIC), repeatedly told outpatient and emergency room providers that he was experiencing homicidal ideation, suicidal ideation, and hallucinations. The exact targets of his homicidal ideation varied, including his neighbor and others. He was hospitalized multiple times, but the symptoms persisted.
On May 9, 2008, Mr. Andrews presented to the WPIC emergency room expressing homicidal ideation toward his “neighbor” but was discharged after a discussion with his outpatient case worker. The following day, he was voluntarily hospitalized for three days. A few days later, he was discharged from the WPIC emergency room after expressing ideation “to kill the next-door neighbor and everyone” (Maas, p 429). On May 25, 2008, he presented to the WPIC emergency room reporting suicidal ideation, homicidal ideation, and voices. He was discharged after his caseworker made a plan to deliver medications to his apartment and transfer him to a personal care home within 36 hours.
On May 29, 2008, Mr. Andrews killed Laura Maas, a 19-year-old culinary arts student, living on the same floor of his apartment building. He told officers: “Take me to jail. I did it” and “I told [a psychiatrist] to put me in Western Psych … I told people I was going to kill someone” (Maas, p 430). Mr. Andrews was convicted of murder and sentenced to life in prison.
The victim's mother filed a wrongful death and survival action against defendants at UPMC alleging that Mr. Andrews' providers had a duty to warn residents of his apartment building, specifically his floor, of his threats. The UPMC defendants moved for summary judgment, arguing that mental health care providers in Pennsylvania have a duty to warn only under limited circumstances under Emerich v. Philadelphia Ctr. for Human Dev., 720 A.2d 1032 (Pa. 1998). According to Emerich, a patient must communicate a “specific and immediate threat” toward a “readily identifiable” victim. UPMC argued that Mr. Andrews' “amorphous, nonimmediate” threats against an unidentifiable “neighbor” or “neighbors” did not create a duty to warn (Maas, p 430). The trial court denied summary judgment, and the Pennsylvania Supreme Court affirmed.
Ruling and Reasoning
The Pennsylvania Supreme Court concluded the lower court did not err in denying the appellants' motion for summary judgment and said that the current record supports a finding that the victim was “readily identifiable.” The majority noted that the providers were well aware that living in the building was a stressor for Mr. Andrews. The providers, they reasoned, could have known on a “moment's reflection” that his statements, including “next door neighbor” and “neighbor who knocked on his door” at night, were references to those living in his building, with whom he had frequent opportunity to interact (Maas, p 439).
The court recognized that Emerich had limited the duty to warn, relying on Thompson v. County of Alameda, 614 P.2d 728 (Cal. 1980), a California Supreme Court case which held that mental health professionals do not have a duty to warn the “public at large” or a “large amorphous group” of threats to unidentified persons. In this case, however, the court argued that the residents in Mr. Andrews' apartment building did not constitute a “large amorphous group.”
Dissent
Justice Baer maintained that the majority's decision significantly departed from Emerich because “neighbor” in an urban setting is not a “readily identifiable” group and could include those in adjacent buildings, the same block, or even in the broader community. Mr. Andrews had never referred specifically to those living on his floor, and he had made threats toward many different groups (e.g., “others” and those who “pissed him off”).
Justice Baer felt that the majority had strayed from the limits to the duty to warn set forth in Thompson, in which there was no duty to warn where a juvenile threatened to kill a neighborhood child. It would be impracticable and ineffective to warn a broad segment of the public. The Emerich court, relying on Thompson, had recognized the importance of feasibility, stating that a mental health professional would have “great difficulty in warning the public at large of a threat against an unidentifiable person” (Emerich, p 1041).
Justice Baer reasoned that requiring providers to broadcast “generalized threats” to “broad segments” of the population could negatively impact the treatment of the mentally ill. Patients could be ostracized from their community and distrust their providers, who had breached confidentiality. Furthermore, increasing liability would threaten to “paralyze” providers who are seeking to provide treatment to a vulnerable population.
Discussion
Since Tarasoff v. Regents of Univ. of California, 551 P.2d 334 (Cal. 1976), courts across the country have grappled with defining the scope of the duty to warn, particularly in cases where patients make generalized threats beyond a specific individual. Many states have cited Thompson, which limited California's duty to warn to “identifiable victims” and excluded “large amorphous groups.”
The vast majority of states with a duty to warn or to protect limit the duty to specific, reasonably identifiable, or clearly identifiable victims. Exceptions include Wisconsin, which includes all “foreseeable victims” (Schuster v. Altenberg, 424 N.W.2d 159 (Wis. 1988)) and Washington, which recognizes a duty to protect anyone who “might foreseeably be endangered” by one's patient in the outpatient context (Volk v. Demeerleer, 386 P.3d 254, 260–261 (Wash. 2016)).
As outlined by the dissent, restricting the duty to warn to “readily identifiable” individuals was intended to prevent limitless liability and recognize practical limitations to mental health care professionals' ability to identify and notify groups that have not been clearly defined. In Maas, it is not clear whether the psychiatrists have the duty to contact the building manager, each individual living in the apartment building, or an even broader group of people.
The majority's interpretation moves closer to a broader foreseeability standard without providing guidance on identifying the victim prospectively. Mr. Andrews' statement, “I told people I was going to kill someone” (Maas, p 430) and his varied and vague descriptions of his targets highlight the lack of specificity in this case. While the Pennsylvania Supreme Court ruled that neighbors were identifiable victims in this case, the question of whether the defendants breached that duty in this case remains to be determined by the finder of fact in a separate trial.
The Maas decision has implications for community integration, confidentiality, and risk assessment. As the dissent points out, the decision has negative implications for patients who will face loss of community and fewer housing options if broad groups are notified about their threats. Furthermore, broadcasting a threat to a large audience could erode the trust patients have in their providers and reduce their engagement in treatment. Together, these factors could significantly increase patients' risk of harm through alienation. It is difficult to imagine that Mr. Andrews could have remained in his building if the residents of the 40-unit building were notified about his threats. While a broad interpretation of “readily identifiable” victims might at first glance appear to protect victims, discharging a warning to a large group may ultimately increase patients' risk of violence.
- © 2021 American Academy of Psychiatry and the Law
