James Stewart was under the care of his psychiatrist, A. K. M. Fakhruddin, from May 1989 until Stewart's death in 2005. He was originally diagnosed with and treated for depression. In 2001, Stewart was hospitalized following an incident of domestic violence and Fakhruddin changed his diagnosis to bipolar disorder. Fakhruddin saw Stewart regularly on an outpatient basis: His last visit with Fakhruddin was on August 23, 2005. On September 9, 2005, Stewart shot and killed his wife (Deloris) while in the presence of Melissa, their grown daughter; his wife Deloris was holding their grandchild at the time that Stewart shot her. Stewart then turned the gun on himself, committing suicide.
Suit was brought by the estates of the Stewarts against Fakhruddin and his employer on two bases: failure to provide appropriate care for Stewart and failure to protect Stewart's wife. Fakhruddin defended on the grounds that his care was within the standard of care and that Deloris Stewart was aware of the danger presented by her husband, so there was no duty to warn. The trial court granted the motion for summary judgment and dismissed the action.
The court of appeals did not rule specifically on the issue of whether Fakhruddin had a duty to warn Deloris Stewart, but did rule that the estates had stated a claim for the negligent care of James Stewart. The court held that the breach in the standard of care, if proved, could be brought for both the homicide of Deloris Stewart and the suicide of James Stewart. The court of appeals reversed the decision of the trial court and sent the matter back for trial.
The issue of negligence, on the other hand, can flow to any victim.
Cases like these normally revolve around the issue of failure to warn. The failure to warn issue, however, flows from a credible threat to the identifiable victim, not to persons who cannot be identified. In this case, while it may be difficult to prove that Deloris Stewart was unaware of her husband's violent tendencies, considering his previous incidents of violence, it may still have been arguably negligent not to warn her; making it sound practice to provide a formal warning to an identifiable victim.
The issue of negligence, on the other hand, can flow to any victim. See, e.g., Bragg v. Valdez, 111 Cal. App. 4th 421, 3 Cal. Rptr. 3d 804 (Ct. App. Cal. 2003). The court in Bragg held that liability may attach when the patient was discharged early from inpatient care, allegedly because he did not have insurance, and went on to kill a stranger. If the estates can show that the care provided by Fakhruddin fell below the standard of care (and the estates provide an expert who would testify to this), then any victim of violence perpetrated by Stewart would potentially have a claim. This reinforces the idea that practitioners need to be duly diligent and give objectively justifiable care, especially with suicidal or homicidal patients. It is important that the assessment and care plan can be defended. If the patient does not currently need inpatient care, this decision needs to be carefully documented so that it can be defended later.
Stewart v. Fakhruddin,
No. M2009-02010-COA-R3-CV
(Ct. App. Tenn. May 26, 2010)
John C. West, J.D., M.H.A., is a senior health care consultant with Global Loss Prevention, Inc., a Chartis company. This column constitutes general advice not legal advice. Readers should consult with counsel for legal concerns. For questions or comments contact john.west2@chartisinsurance.com.