Behavioral Health: Court Expands Outpatient Mental Health Providers’ Duty to Third Parties

​The Washington state supreme court, in a ruling that expands the scope of liability for providers of outpatient mental healthcare in the state, held that a psychiatrist may be civilly liable for homicides committed by an outpatient, even though the patient never communicated a threat of violence against any reasonably identifiable victim or victims. The case involved a murder-suicide committed by a man the defendant psychiatrist treated for bipolar and associated disorders for nine years. At the patient's final visit with the psychiatrist before the murder-suicide, the psychiatrist noted he was in a "hypomanic mood" but with "judgment and insight intact." The note described the patient as "logical" and his life as "stable," and said that the patient reported that when he was depressed he had suicidal ideation that he would not act upon. He and his fiancée were "taking marriage classes," the psychiatrist's note continued, repairing their relationship after his fiancée had terminated a pregnancy. Three months later, the patient's fiancée ended her relationship with the patient. One week after that, the patient entered her house and shot and killed her and her nine-year-old son, attacked another son with a knife, and then took his own life. The deceased woman's mother and the fiancée's surviving son sued the psychiatrist and his clinic for medical negligence, claiming failure to schedule the patient for follow-up visits; failure to conduct an adequate suicide risk assessment; failure to provide more intensive treatment; and failure to involuntarily commit the patient pursuant to a state civil commitment statute.