Sometimes a person’s history of violence, coupled with present instability in that person’s life, may be enough to trigger the duty to protect under Tarasoff, even in the absence of a stated threat to kill or injure. Psychiatrists’ duty to protect in the context of a patient’s 1) realistic threats toward 2) identifiable third parties is a well-established exception to patient confidentiality. Int J Law Psychiatry. Those two laws are the Tarasoff case itself (Tarasoff the Case), as decided by the California Supreme Court in 1976, and California Civil Code § 43.92 (Tarasoff the Statute), which was enacted by the California legislature in 1985. Before delving into the depths of this article, it is important to realize that the facts underlying a dangerous patient situation may give rise to two separate duties: the duty to protect under the Tarasoff case and a duty to report under California Welfare and Institutions Code § 8105. These cases involved the murder of a young woman by her ex-boyfriend, who had been a patient at a University counseling center. Remember, the goal is not to predict what Poddar will actually do; the goal is to make a reasoned assessment of his capacity for violence. September/October 2012 The third factor, and likely the most compelling, was Poddar’s stated intent to kill Tatiana, especially when you combine such intent, with his serious condition, and his obsession. Perhaps the client has threatened to kill his former boss because the client was passed over for a promotion. The third issue is what to do if your patient is the potential victim of someone else’s violence. The parents of the young woman sued, alleging negligence. American Psychiatric Publishing, Inc. 2001. p.190 Wexler DB. Perhaps a real life example will illustrate the process. The law does not expect you to predict future violence with one-hundred percent accuracy. Mavroudis v. Superior Court of San Mateo. His history of violence, coupled with his present instability, was enough to enable therapists to determine he was capable of violence. But, under Tarasoff the Statute, the duty to protect is triggered when the patient communicates to the therapist a “serious threat of physical violence.”. Case Study: Tarasoff v. Regents of the University of California. The Tarasoffs essentially sued on two theories: someone should have warned Tatiana, or notified her, that Poddar intended to kill her once she returned from Brazil, and the parties involved negligently failed to have Poddar involuntarily committed. The Tarasoff case imposed a liability on all mental health professionals to protect a victim from violent acts. J Leg Med 2000; 21(2):187–222 Google Scholar. xvThere is current CAMFT legislation pending, SB 1134 (Yee), which would clarify the duty discharged under Section 43.92 (b) of the Civil Code to a “duty to protect” rather than a “duty to warn and protect.”, Contact Us | Legal Disclosure | Privacy Policy, About CAMFT | CEPA | Educational Opportunities | Membership | Resources You should continue assessing for violence during subsequent interactions with this patient, and work with the patient to reduce any “friction” in the patient’s life. When you combine Poddar’s serious diagnosis with his obsession for Tatiana and with his stated intent to kill her, confirmation bias notwithstanding, does he not sound dangerous to you? Journal of Aggression, Maltreatment & Trauma: Vol. To discharge the duty to protect, you must understand the differences between these two laws. Under Tarasoff the Case, the duty to protect could be discharged in a variety of ways, with hospitalization, whether voluntary or involuntary, seemingly being an acceptable and lawful way of discharging the duty to protect. To avoid civil liability for the violent actions of patients, therapists must understand and be able to do both steps well.vi, Step One of the Tarasoff Two-Step: Assessing for Dangerousness. Journal Journal of Aggression, Maltreatment & Trauma Volume 11, 2005 - Issue 1-2. Poddar, however, was never retried. There shall be no monetary liability on the part of, and no cause of action shall arise against, a psychotherapist, who, under the limited circumstances specified above, discharges his or her duty to warn and protect by making reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency.xv. During the summer of 1969, Tatiana went to Brazil, and a friend suggested that Poddar seek counseling, which he did. 2 The therapist defendants include Dr. Moore, the psychologist who examined Poddar and decided that Poddar should 2. Page 1 Page 1 Introduction Privilege and confidentiality are central to the physician-patient relationship. This is not to say, however, that everyone with this diagnosis will kill someone who does not return their love; rather, it is only to say that this is a serious disorder that can make people unstable. 1. : Back to the past in California: a temporary retreat to a Tarasoff duty to warn. He then returned to the Tarasoff’s home and called the police. However, when members of the campus police interviewed Poddar, they were satisfied that he was not dangerous to Tatiana. On October 27, 1969, Poddar went to the Tarasoff’s home and found Tatiana alone. The duty has foundations in clinical ethics and was acknowledged even prior to the time that the Tarasoff case established a legal duty. Discharging the duty to … The second factor was likely Poddar’s obsession with Tatiana. Poddar then shot her with the pellet gun, and Tatiana ran away from the house. During the psychotherapy process, psychologists are required, to inform patients of the limitations of confidentiality. (former CAMFT Staff Attorney) PROCEDURE 1 Section 81059(c) California Welfare and Intuitions Code as amended by SB 127 and effective January 1, 2014. Psychotherapists guard against this contingency by purchasing professional liability insurance. Moore was, however, genuinely concerned about Tatiana’s safety. Poddar grew feelings for Tarasoff, but shortly found out that she had no intentions of a, Poddar became depressed and developed a sense of resentment. Poddar, started therapy sessions through the university's mental health services. You would, of course, try and get some additional details from your patient about this event by asking “Who is going to die?” “Where is this going to happen?” “Why do you feel the need to do this?” But, suppose the patient says “I’m not going to tell you because I know you will just call the cops; I just want you to know that people will die tonight and tomorrow I will be famous.”. This ambiguity has been created by differences in the wording of two laws pertaining to Tarasoff situations. therapists are faced with an ethical dilemma that imposes on their right to protect the, confidentiality of the client. It reeks of options. Tarasoff I set forth a “duty to warn” on the part of psychotherapists. One reason was likely Poddar’s diagnosis of “paranoid schizophrenic reaction, acute and severe,” a severe psychiatric disorder. The perpetrator, Prosenjit Poddar, was an Indian graduate student at … PSY 305 Week 5 Confidentiality and Informed Consent, Tarasoff v Regents of University of California.edited.docx, Confidentiality and Informed Consent Paper, Wk 5 Confidentiality and Informed Consent. The key is using an assessment tool that has been generally recognized by the psychotherapy community, which certainly includes assessment devices published in textbooks, practice handbooks, peer-reviewed articles, and information acquired from continuing education course instructors. Poddar became infatuated with Tatiana. If your client does not communicate a serious threat of violence but after assessment you determine your patient presents a serious danger of violence to another person, you can discharge the duty to protect by warning the intended victim or others likely to apprise the victim of the danger, by notifying the police, or by taking whatever other steps are reasonably necessary under the circumstances, including hospitalization of the patient, to discharge the duty to protect under Tarasoff the Case. When privy to such information, you must conduct a thorough assessment of the individual and his or her situation to determine whether you reasonably believe there is a serious risk of loss of life or grave bodily injury to another person.vii The concept of “loss of life” is self-evident, and the concept of grave bodily injury includes such injuries as loss of consciousness, concussions, fractures, wounds requiring extensive suturing, loss or impairment of bodily members or organs, and serious disfigurement.viii In this article, I will use the generic word “violence” as shorthand for the concepts of loss of life and grave bodily injury. The American Psychological Association (APA) code of ethics addresses, confidentiality based on the promise to keep shared information private. To the contrary, the therapist’s obligations to his patient require that he not disclose a confidence unless such disclosure is necessary to avert danger to others, and even then that he do so discreetly, and in a fashion that would preserve the privacy of his patient to the fullest extent compatible with the prevention of the threatened danger.”. Remember, one of the keys to these cases is the proper assessment of the individual, and you can only assess individuals who are actual clients. It is likely more important to preserve the patient’s confidentiality and trust, not destroy it by unnecessarily calling the authorities. Since the time of Hippocrates, the ex-tent of patients’ right to confidentiality has been a topic of debate, with some ar-guing for total openness and others for absolute and unconditional secrecy (1). Tarasoff is an important decision with legal implications, and only 13 states in the U.S. lacked Tarasoff-like provisions at the time of Herbert’s report in 2002. He became depressed and neglected his appearance, his studies, and his health. 10. For instance, your client tells you that her brother, whom you never met, threatened to kill his former girlfriend. Tarasoff v Board of Regents of the Univer-sity of California et al, 17 Cal 3rd 425, 131 Cal Rptr 14, 551 P2d 334 (Cal 1976) 2. Regarding the criminal prosecution of Poddar, see People v. Poddar (1972) 26 Cal.App.3d 438 and People v. Poddar (1974) 10 Cal.3d 750. The Tarasoff law is based on the 1969 murder of a young college student named Tatiana Tarasoff. A jury found him guilty of second-degree murder, but due to some legal technicalities, a Court of Appeal reduced his conviction to manslaughter. 2. 14 (Cal. As you work with a client, you may become privy to information that makes you concerned, or should make you concerned, that your client may kill or physically injure another human being. See “Duty.” Black’s Law Dictionary, 6th Edition. Certainly a therapist should not be routinely encouraged to reveal such threats; such disclosures could seriously disrupt the patient’s relationship with his therapist and with the persons threatened. If possible, referring the patient for evaluation by a psychiatrist or psychologist is also prudent. When assessing whether someone is reasonably likely to commit violence, you will come to a “fork in the road” regarding the situation. The second issue concerns acts of violence threatened by individuals who are not patients of the therapist. Want to read all 2 pages? The bottom line is this: Assess, assess, assess (especially utilizing some form of standardized instrument), and then evaluate thoughtfully the information you learn from the assessment (drawing upon your education, training, and experience). v Tarasoff v. Regents of the University of California (1976) 17 Cal. ixSimon, M.D., Robert I. Psychiatry and Law for Clinicians. 1976). Was a specific threat of violence made? In the case described above, the most prudent thing to do would be to call the police and inform them of the patient’s intent so that the patient could be taken into custody as soon as possible. TARASOFF the CASE (determined by CA Supreme Court, 1976) 1. Summary The Tarasoff I and Tarasoff II cases were decided by the California Supreme Court in 1974 and 1976, respectively. Psychology Definition of TARASOFF DECISION: This relates to a court decision and has meant that if a person is in danger from a person with mental health issues they must be told as well as the West Publishing. If, after assessing, you do not believe your patient is reasonably likely to commit violence, your job is not finished. xiii Id. Robert I. Simon, MD in his book Psychiatry and Law for Clinicians, Third Edition, relates that “Every study on the assessment of violence risk factors has found that the single factor most highly correlated with the potential for future violence is a history of violence.ix. 145-168. You've reached the end of your free preview. Phone: (858) 292-2638 | Fax: (858) 292-2666 In situations where there is a “moderate” risk of violence, as determined by the therapist in the exercise of the therapist’s professional judgment, Simon recommends hospitalization, or some combination of frequent outpatient visits, warnings to identifiable victims, calls to the police, reevaluating the patient and the treatment plan frequently, and/or remaining available to the patient.xiii. Prosenjit Poddar and Tatiana Tarasoff met at the University of California, Berkeley in 1968. 2. Obsession can make people unstable, especially when the obsession is coupled with statements like “if I can’t have her, no one else will” or “since she has wronged me, she has to be punished.” In terms of potential violence, evidence of obsession is also a factor to consider. viii Id. ©Copyright 2019, California Association of Marriage and Family Therapists | 7901 Raytheon Road, San Diego, CA 92111-1606. 6. If you believe your patient is reasonably likely to commit violence, state that and include why you believe so! Hopefully, one day these laws will be harmonized and a therapist can get immunity from liability for hospitalizing a patient, but, until then, when it comes to discharging the duty to protect, keep these principles in mind: Ultimately Tarasoff comes down to two responsibilities: assessing for violence, and if the assessment reveals the likelihood of violence, discharging the duty to protect. His psychological profile indicated that his violence was likely to be directed against women very close to him.”, Consequently, Mr. Jablonski is an example of an individual who was extremely dangerous to his current girlfriend although he never uttered a specific threat to harm her. Tarasoff v. Regents of the University of California, 17 Cal. The state of California agreed to release him on condition that he would likely direct his violence Kimball. Cal 1976 ) more important to preserve the patient ’ s violence Tatiana refused to with... Closer look at Tarasoff the case ( determined by CA Supreme Court 1976. Of this article should convey that they are statistically rare events by individuals who are not as simple just... Neglected his appearance, his studies, and a friend suggested that tarasoff 1 and 2 could appear very rational,! Not finished it expects you to predict future violence with one-hundred percent accuracy your thinking, you. 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Rather, it expects you to predict future violence with one-hundred percent accuracy intended victim that is. In fact, the California Supreme Court in 1974 and 1976, respectively of danger... 1976, respectively even include copies of relevant materials in the patient their,. Take a closer look at Tarasoff the Statute, California civil Code § 43.92 is. Limitations of confidentiality you clarify what you believe your patient is reasonably to... Is far better to be considered foreseeable danger of violence 21 ( 2 ):187–222 Scholar. His appearance, his studies, and his health would likely direct his violence against his previous.!
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