This statute says: There shall be no monetary liability on the part of, ..., any person who is a psychotherapist in failing to warn of and protect from a patient’s threatened violent behavior or failing to predict and warn of and protect from a patient’s violent behavior except where the patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims. However, under Tarasoff the Statute, to discharge the duty to protect, one must make reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency. 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. On August 18, 1969, he was a voluntary outpatient at Cowell Memorial Hospital. Upon the student’s arrival to school in the morning the student will meet his one on one aide, check in with his counselor every morning in the office and go to the Cafeteria until the second bell for his first hour class. The American Psychological Association (APA) code of ethics addresses, confidentiality based on the promise to keep shared information private. 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. The assessment should help you clarify what you believe about the patient’s capacity for committing violence. It is possible, even likely, that although the patient said he would kill his former boss, an assessment of the patient reveals that there really is not a serious risk of violence against the boss because the patient was merely jesting or talking tough. The intended victim must be reasonably identifiable. Thus, it may call for him to warn the intended victim or others likely to apprise the victim of the danger, to notify the police, or to take whatever other steps are reasonably necessary under the circumstances.”v, This duty to protect can be compartmentalized into two steps: the first is an “assessment” step. Course Hero is not sponsored or endorsed by any college or university. The law does not expect you to predict future violence with one-hundred percent accuracy. In terms of potential violence, it is a factor to be considered. 7. Was a specific threat of violence made? The second factor was likely Poddar’s obsession with Tatiana. The therapist does not have to hear the threat directly from the patient. The parents of the young woman sued, alleging negligence. One reason was likely Poddar’s diagnosis of “paranoid schizophrenic reaction, acute and severe,” a severe psychiatric disorder. x Ewing v. Goldstein (2004) 120 Cal.App.4th 807 2 The therapist defendants include Dr. Moore, the psychologist who examined Poddar and decided that Poddar should Journal Journal of Aggression, Maltreatment & Trauma Volume 11, 2005 - Issue 1-2. 1. The Therapist In that case, Mr. Jablonski was considered to be very dangerous to Ms. Kimball, although he never actually threatened her. It reeks of options. Immunity from liability means that even if your patient actually goes out and harms intended victims, if you have accomplished the two parts required by Tarasoff the Statute, you cannot be held financially responsible for the violent acts of your patient. Since some reading this article may be encountering the “dangerous patient” issue for the first time, it seems prudent to review the factual background to the Tarasoff casesii for context. He had raped and committed other acts of violence against his previous wife. Chapter Information  |    Advocacy   |    CAMFT Community   |    Advertising    |  CounselingCalifornia.com, California Association of Marriage and Family Therapists   |  7901 Raytheon Road, San Diego, CA 92111-1606   Poddar then stopped attending therapy with Moore. The Tarasoff law is based on the 1969 murder of a young college student named Tatiana Tarasoff. 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. It does not prescribe one way to address dangerous patient situations. Want to read all 2 pages? of Cal. Perhaps the client has suffered a psychotic break and believes God has commanded him to sacrifice his daughter to atone for the sins of Hollywood. American Psychiatric Publishing, Inc. 2001. p.189. 10. : Back to the past in California: a temporary retreat to a Tarasoff duty to warn. 1974). Case Study: Tarasoff v. Regents of the University of California. In fact, the earlier phrase was accurate, the later one rhetorical and misleading. ©Copyright 2019, California Association of Marriage and Family Therapists   |  7901 Raytheon Road, San Diego, CA 92111-1606. His history of violence, coupled with his present instability, was enough to enable therapists to determine he was capable of violence. Moore was, however, genuinely concerned about Tatiana’s safety. Application by the court of the overriding objective 1.2 The court must seek to give effect to the overriding objective when it – (a) exercises any power given to it by the Rules; or (b) interprets any rule subject to rules 76.2, 79.2 and 80.2. Does it sound like Tarasoff the Case and Tarasoff the Statute are playing the same “tune” or different “tunes?” There seem to be three significant differences between Tarasoff the Case and Tarasoff the Statute. 1 Plaintiffs, Tatiana's parents, allege that two months earlier Poddar confided his intention to kill Tatiana to Dr. Lawrence Moore, a psychologist employed by the Cowell Memorial Hospital at the University of California at Berkeley. The perpetrator, Prosenjit Poddar, was an Indian graduate student at … 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. 2. The utilitarian and the categorical imperative viewpoints respond to the ethical dilemma raised in Tarasoff in two very different ways. Think back to the Jablonski case. The differences in the language used raise a key question: Do you need an actual threat of violence before you can determine whether someone is dangerous to another person? 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. Weinstock R, Vari G, Leong GB, et al. However, when members of the campus police interviewed Poddar, they were satisfied that he was not dangerous to Tatiana. Tarasoff’s family sued the campus police and the university health service for negligence. 2 Under no circumstances can notification to a law enforcement agency occur more than twenty four (24) hours from the time the clinician learned of the threat. 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. But, under Tarasoff the Statute, the duty to protect is triggered when the patient communicates to the therapist a “serious threat of physical violence.”. If your patient is the potential victim of violence, you should be working with your patient to formulate a safety plan for that person. The second issue concerns acts of violence threatened by individuals who are not patients of the therapist. In some cases, hospitalization may be most appropriate. The psychologist, Dr. Lawrence Moore, notified, Tarasoff v. Regents of the University of California. Such a situation is not Tarasoff because the client’s brother is not your patient. Is immunity from liability available? Poddar became infatuated with Tatiana. (2020). This article, however, could just as easily been titled “The Tarasoff Three-Step.” 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.”. Tatiana refused to speak with him and she screamed. 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. He became a loner, stayed in bed interminably, spoke disjointedly, and often wept. The State of California agreed to release him on condition that he leave the United States immediately, which he did. The reason your professor did not mention hospitalization as an option is likely because the professor focused only on Tarasoff the Statute, but ignored Tarasoff the Case. One never really knows when the discordant music of a dangerous patient situation may begin to play, and the time to “dance” has arrived. He confided to a friend that he loved Tatiana, but thought about killing her by blowing up her room. Rather, it expects you to assess for the likelihood of violence by utilizing your education, training, and experience. American Psychiatric Publishing, Inc. 2001. p.190 This ambiguity has been created by differences in the wording of two laws pertaining to Tarasoff situations. David Jensen, JD Buckner F, Firestone M: "Where the public peril begins": 25 years after Tarasoff. Step Two of The Tarasoff Two-Step: Discharging the Duty to Protect. The California Supreme Court's initial decision in the case is at 529 P.2d 553 (Cal. He then returned to the Tarasoff’s home and called the police. It is likely more important to preserve the patient’s confidentiality and trust, not destroy it by unnecessarily calling the authorities. Tarasoff cases can be complex, but fortunately they are statistically rare events. He heard her say that while she was in Brazil, she had an affair with another man. 6. Note, and this is crucial, that there is no automatic immunity for taking reasonable steps to discharge the duty to protect under Tarasoff the Case. in 1976. The duty has foundations in clinical ethics and was acknowledged even prior to the time that the Tarasoff case established a legal duty. They saw each other weekly throughout the fall of 1968, and on New Year’s Eve Tatiana kissed Poddar, which caused him to believe they were involved romantically. Thus, it may call for him to warn the intended victim or others likely to apprise the victim of the danger, to notify the police, or to take whatever other steps are reasonably necessary under the circumstances.”. Tarasoff v Regents of the University of California, 551 P2d 334 (Cal 1976). The Tarasoff case imposed a liability on all mental health professionals to protect a victim from violent acts. Despite the fact that Poddar had expressly stated he would kill Tatiana when she returned from Brazil, no one communicated such intent to Tatiana or to a member of her family. But, as of right now, Tarasoff the Case permits an activity, such as hospitalization, that Tarasoff the Statute does not grant immunity for, which is unfortunate. For purposes of this article, I am blending facts from the civil and criminal cases to help the reader better understand the issue. Poddar, however, was never retried. 2. While in therapy, Poddar, expressed his intentions to kill Tatiana Tarasoff. [Vol. The relevant principles of law run much deeper than those ideas. Consequently, although Moore sought to have Poddar involuntarily committed, the campus police disregarded Moore’s recommendation and Poddar remained free. Perhaps the client has threatened to kill his former boss because the client was passed over for a promotion. Page 1 Page 1 Introduction Privilege and confidentiality are central to the physician-patient relationship. xii Id. It is a myth to believe that every threat uttered by a patient must result in Tarasoff warnings; it is a truism to believe that every threat must be assessed. Walcott, Cerundolo, and Beck (2001) cite the second Tarasoff case, establishing a duty to protect. The third issue is what to do if your patient is the potential victim of someone else’s violence. Consulting with colleagues who are knowledgeable about these issues is always prudent and recommended. This article is only about the duty to protect, specifically how it is created and how it is discharged. 2. During the summer of 1969, Tatiana went to Brazil, and a friend suggested that Poddar seek counseling, which he did. 1979;2:1-28. Poddar then shot her with the pellet gun, and Tatiana ran away from the house. Poddar confided to Lawrence Moore, a staff psychologist at Cowell, that he was going to kill an unnamed girl when she returned from Brazil. When the police arrived, Poddar asked to be hand-cuffed.iii. i Some theorists believe there are actually three steps in the Tarasoff process, gathering information, evaluating information, and then acting on the evaluated information, but I have chosen to combine the activities of gathering and evaluating information into one process. Poddar grew feelings for Tarasoff, but shortly found out that she had no intentions of a further relationship. Thus, Tarasoff the Case provides three options and Tarasoff the Statute offers two options. 1976). The issue was addressed by the California Supreme Court in Tarasoff and the court explained that: “We realize that the open and confidential character of psychotherapeutic dialogue encourages patients to express threats of violence, few of which are ever executed. 11.Palsgraf v Long Island Railroad Co, 162 NE 99 (NY 1928). viii Id. He sought treatment from Lawrence Moore, a psychologist at Berkeley’s Cowell Memorial Hospital.In his seventh and final therapy session, Poddar t… xiii Id. The discharge of this duty may require the therapist to take one or more of various steps, depending upon the nature of the case. Conversely, if you do not believe your patient is reasonably likely to commit violence, state that and why you believe so! In a mass murder situation, there could be no identifiable victims to warn, but there could be intended/foreseeable victims to try and protect. 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. If you believe your patient is reasonably likely to commit violence, state that and include why you believe so! Imminence is necessary for Tarasoff duty to exist. iv By a “duty” the law means an obligation requiring the actor to conform to a certain standard of conduct for the protection of others against unreasonable risks. Ultimately, those reasons and judgments will come from your understanding of your patient, from your understanding of human behavior, and from your understanding of the factors that can lead to violence. Prosenjit Poddar, a University of California graduate student, developed an infatuation with Tatiana Tarasoff, a woman he met at a dance class. He contacted campus police via the telephone and via letter, and even warned the police that Poddar could appear very rational. the Tarasoffcase 3 1 2 2 4 .4 .51 2 6 1 2 1.4 .28 ... 1. A history of DTW laws. 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. 9 . Think back to the Tarasoff case. This dance is called The Tarasoff Two-Step.i Some therapists resist learning it because they believe they will have only high-functioning, stable clients. 3d 425 The duty to protect is triggered when the clinician “determines that a patient presents a serious danger of violence to another.” An actual threat of violence is unnecessary. Hedlund v. Superior Court of Orange County. A jury found him guilty of second-degree murder, but due to some legal technicalities, a Court of Appeal reduced his conviction to manslaughter. Patients seeking therapy have the right to privacy in their relationship with their, psychologists. There may have been other reasons, but from the information chronicled in the published cases, these three seem to be the ones most acute at the time. TARASOFF the CASE (determined by CA Supreme Court, 1976) 1. The Duty to Protect: Four Decades After Tarasoff Ahmad Adi, M.B.B.S., M.P.H., Mohammad Mathbout, M.B.B.S. This preview shows page 2 - 3 out of 5 pages. 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). 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.”. 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. Discharging the duty to … This article should convey that they are not as simple as just calling the police and just warning identifiable victims. The story begins in 1968 when Prosenjit Poddar, an Indian graduate student at UC Berkeley, met Tatiana Tarasoff while she was attending folk dancing classes at the International House, which is where Poddar lived. xiv Id. This article is not about the duty to report, which is discussed in a separate article by David G. Jensen, JD. vi Based on the Tarasoff case, the failure of a psychotherapist to properly discharge the duty to protect can result in civil liability for such psychotherapist, which means that such therapist would have to pay compensation to victims of any violence wrought by the therapist’s patient. West Publishing. Breaches of confidentiality have long been considered unethical and, in many situations, actionable. After meeting Indian graduate student, Prosenjit Poddar, at a folk dancing class, Tatiana agreed to go on several dates with him but soon called it off after getting into a disagreement over the seriousness of their relationship. Reviewed October, 2017 by David G. Jensen, JD (CAMFT Staff Attorney) Two years later, the California Supreme Court vacated his conviction entirely and ordered a new trial. As a graduate student at Berkeley in the late 1960s, Prosenjit Poddar became enamored with, and ultimately unsuccessful in courting, Tatiana Tarasoff. 1 The criminal prosecution stemming from this crime is reported in People v. Poddar (1974) 10 Cal.3d 750 [111 Cal.Rptr. Tarasoff 1, 529 P.2d 553 (Cal. 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 murder of Tatiana Tarasoff by Prosenjit Poddar resulted in five published legal opinions by various California courts: Regarding the wrongful death action filed in civil court, see Tarasoff v. Regents of the University of California (1973) 33 Cal.App.3d 275; Tarasoff v. Perhaps the client has a history of beating-up previous wives or girlfriends and that “history” is about to manifest itself now with the client’s current wife or girlfriend. Has this person killed or injured people before? Tarasoff and the Duty to Protect. A third difference between Tarasoff the Case and Tarasoff the Statute is the difference in options available to discharge the duty to protect, once it has been triggered. Within the broad range of reasonable practice and treatment in which professional opinion and judgment may differ, the therapist is free to exercise his or her own best judgment without liability; proof, aided by hindsight, that he or she judged wrongly is insufficient to establish negligence.”. Perhaps a real life example will illustrate the process. Tarasoff at Thirty psychotherapists had an affirmative duty to warn Tarasoff of the threat Poddar posed.' 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. See “Duty.” Black’s Law Dictionary, 6th Edition. So, are you ready to do The Tarasoff Two-Step? Volume 11, Issue 1-2 Tarasoff and the Duty to Protect Search in: Advanced search. The inception of DTW laws came at the ruling of Tarasoff v. Regents of Univ. In discussing this issue, the California Supreme Court in Tarasoff explained that: “We recognize the difficulty that a therapist encounters in attempting to forecast whether a patient presents a serious danger of violence. 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. He had diagnosed Poddar with “paranoid schizophrenic reaction, acute and severe,” and he attempted to have Poddar hospitalized on a 72-hour hold. These concepts are protected by law in almost all jurisdictions1,2. 551 P.2d 334 (Cal. He was armed with a pellet gun and a kitchen knife. Int J Law Psychiatry. In Psychiatry and Law for Clinicians, Dr. Simon envisions three types of Tarasoff situations and recommends a plan of action for each of them.xi In situations where there is a “low” risk of violence, as determined by the therapist in the exercise of the therapist’s professional judgment, Simon recommends continuing with the treatment plan to reduce “friction” in the patient’s life.xii In these kinds of cases, there is no need to call the police or warn identifiable victims. As part of a thorough assessment, you should also be aware of the presence of any firearms or other dangerous weapons. Journal of Aggression, Maltreatment & Trauma: Vol. On October 27, 1969, Poddar went to the Tarasoff’s home and found Tatiana alone. If your patient communicates to you a serious threat of physical violence against a reasonably identifiable victim or victims, and you reasonably believe your patient is likely to commit such violence after assessing for it, you can discharge the duty to protect by making reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency, which will get you immunity from liability under Tarasoff the Statute, if your patient actually harms such victims. 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. My professor never mentioned hospitalization as an option.”. He became depressed and neglected his appearance, his studies, and his health. Under Tarasoff the Case, the duty to protect is triggered when the therapist “determines” that a patient presents a serious danger of violence to another. As I mentioned before, to do The Tarasoff Two-Step well, you have to account for both laws in your thinking. Rptr. amend.2 This appeal ensued. 11, No. [3] This case determined that the clinician has the duty to warn an identifiable victim. 1976), was a case in which the Supreme Court of California held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient. The discordant music of a dangerous patient situation is now playing in the background. The lawsuit filed by the Tarasoffs was ultimately heard by the California Supreme Court twice, which is remarkable in itself, and on July 1, 1976, the court announced the following ground-breaking dutyiv for psychotherapists: “When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. Nevertheless, Jablonski’s previous history indicated that he would likely direct his violence against Kimball. The duty has foundations in clinical ethics and was acknowledged even prior to the time that the Tarasoff case established a … Is hospitalization a viable option for this patient? 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. Submit an article Journal homepage. J Leg Med 2000; 21(2):187–222 Google Scholar. Duty to warn means that the social worker must verbally tell the intended victim that there is a foreseeable danger of violence. Potential victim = “intended victims” 3. In Jablonski, the United States District Court explained that “Unlike the killer in Tarasoff, Jablonski made no specific threats concerning any specific individuals. The legal duty of a psychiatrist or psychotherapist to warn an identifiable victim of a patient's serious threat of harm has been well recognized in U.S. jurisprudence and clinical practice since the Tarasoff v.Regents of the University of California 1 decision of the Supreme Court of California in 1976. PROCEDURE 1 Section 81059(c) California Welfare and Intuitions Code as amended by SB 127 and effective January 1, 2014. Such situations could, however, result in the reporting of suspected child, elder, or dependent adult abuse, depending on the facts. Either you believe your patient is reasonably likely to commit violence, or you don’t: Of course, your records need to reflect these decisions and document the rationale for them. 145-168. In fact, such activity may actually increase the likelihood of violence occurring. Psychotherapists guard against this contingency by purchasing professional liability insurance. Tarasoff v. Regents of the University of California, 17 Cal. Physician-Patient relationship ( APA ) Code of ethics addresses, confidentiality of the limitations of confidentiality notified, Tarasoff on..., psychologists ; 21 ( 2 ):187–222 Google Scholar police via the telephone and via,! California Welfare and Intuitions Code as amended by SB 127 and effective January 1, 2014 future with! Very dangerous to Ms. Kimball, although Moore sought to have Poddar involuntarily committed, the police... 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