Althaus by Althaus v. Cohen
| Decision Date | 13 April 1998 |
| Citation | 710 A.2d 1147 |
| Parties | Nicole L. ALTHAUS, a minor by Richard T. ALTHAUS and Cheryl Renee Althaus, her parents and natural guardians, and Richard T. Althaus and Cheryl Renee Althaus, Appellees, v. Judith A. COHEN, M.D. and University of Pittsburgh Western Psychiatric Institute and Clinic, Appellants. Nicole L. ALTHAUS, a minor by Richard T. ALTHAUS and Cheryl Renee Althaus, her parents and natural guardians, and Richard T. Althaus and Cheryl Renee Althaus, Appellants, v. Judith A. COHEN, M.D. and University of Pittsburgh Western Psychiatric Institute and Clinic, Appellees. |
| Court | Pennsylvania Superior Court |
Larry S. Silverman, Pittsburgh, for Cohen and University of Pittsburgh Western Psychiatric Institute and Clinic.
Martha S. Bailor, Pittsburgh, for Althaus.
Before McEWEN, President Judge, and CAVANAUGH, BECK, TAMILIA, KELLY, JOHNSON, HUDOCK, EAKIN and SCHILLER, JJ.
We are asked to decide whether a psychiatrist who treats a child for alleged sexual abuse owes a duty of care to the parents of that child where the psychiatrist negligently diagnoses and treats the child and then, based on that misdiagnosis, subsequently embarks upon a course of action that directly affects both the child and the parents, as the alleged abusers. This is an issue of first impression. We have considered the competing policies involved, the case law of Pennsylvania and other jurisdictions, and the particular circumstances of this case. In doing so, we must conclude that, despite the absence of a psychiatrist-patient relationship between the psychiatrist and parents in this case, the psychiatrist owed them a duty of care because the psychiatrist's actions extended well-beyond the psychiatric treatment of the child. Further, after reviewing all of the parties' issues in this cross-appeal, we affirm the judgment in all respects.
Nicole Lynn Althaus was born on April 10, 1975, to Richard and Renee Althaus (the Althauses). Beginning in 1990, a series of catastrophic illnesses struck the Althaus family when Renee was diagnosed with skin and breast cancer. Richard's mother was then diagnosed with diabetes and pancreatic cancer, from which she eventually died. As a result, Nicole's emotional and psychological well-being began to deteriorate.
Nicole confided this information to one of her teachers, Priscilla Zappa, and they became quite close. Zappa assisted Nicole in calling a cancer support hotline to provide Nicole with further emotional support during this time. Nicole then spoke to Connie Lappa, who was coincidentally Renee's counselor in a cancer support group at Magee Women's Hospital. After several phone conversations, Nicole confided in Lappa that her father had touched her inappropriately. Lappa then reported Nicole's allegations of abuse to the Allegheny County Children and Youth Services (CYS).
CYS then caused Nicole to be removed from her parents' home. CYS further referred the matter to the Mt. Lebanon Police Department which arrested Richard Althaus and charged him with sexually abusing Nicole. Subsequently, Dr. Susan Nathan, a clinical psychologist, referred Nicole to Dr. Judith Cohen and the Child and Adolescent Sex Abuse Clinic of the University of Pittsburgh Western Psychiatric Institute and Clinic (WPIC).
At trial, Dr. Cohen testified at length about the clinic's role in treating sexually abused children. Dr. Cohen stated that the clinic was a treatment program and did not provide forensic or investigative evaluations. N.T., December 12, 1994, at 16-18. She further stated that the determination of child abuse was made before the child came for treatment and, to that extent, the clinic relied "on the investigations provided by [CYS] and/or forensic evaluations done by independent evaluators of Family Intervention Center." Id. at 17-18. In accordance with her practice, Dr. Cohen did not make any determination about the truth of Nicole's allegations. Instead, Dr. Cohen relied on the conclusions made by CYS and Dr. Nathan that Nicole was sexually abused. Dr. Cohen accepted this determination despite the fact that Dr. Mary Carrasco, a physician who examined Nicole for physical signs of abuse, expressed her concern to Dr. Cohen about some of Nicole's allegations. Dr. Carrasco informed Dr. Cohen that Nicole had made disturbing allegations for which Dr. Carrasco had found no supporting physical evidence. Dr. Cohen stated that she was not surprised that there was no physical findings since she, too, was somewhat skeptical about Nicole's allegations regarding ritualistic abuse. Id. at 38. However, Dr. Cohen's skepticism did not affect her acceptance that Nicole was sexually abused. She also made no independent investigation regarding the reports made by Nicole to other individuals. As a result, Dr. Cohen treated Nicole as though she were suffering from post-traumatic stress disorder and depression secondary to sexual abuse.
As Nicole progressed through therapy, her stories became increasingly outlandish, including not only sexual abuse but also ritualistic torture and the murder of several babies that Nicole claimed to have had via caesarian section. Her allegations of abuse widened to include all members of her immediate family, coworkers of her father, and eventually strangers. Consequently, Richard Althaus was arrested three times and Renee was arrested twice during the course of Nicole's treatment with Dr. Cohen.
Nevertheless, Dr. Cohen steadfastly refused to evaluate the credibility of Nicole's statements throughout treatment, despite her awareness of the criminal proceedings against the Althauses and the fact that many of Nicole's allegations of abuse could not be true. While Dr. Cohen was concerned about these fantastical allegations, Dr. Cohen generally avoided direct confrontation with Nicole because of her concern that Nicole would no longer trust her and because she feared that Nicole would make even more of such allegations.
During Nicole's treatments, Dr. Cohen refused input from the Althauses, as well as Dr. Alan Axelson, a child psychiatrist retained by the Althauses, and Dr. Hilda Schoor-Ribera, Renee Althaus's cancer support therapist. Despite Dr. Cohen's insistence that Nicole's treatment remained strictly therapeutic, she was actively involved in the criminal proceedings against Nicole's parents and the continued placement of Nicole in a foster home. At a meeting with members of the police investigation team, Dr. Cohen refused to comment on Nicole's credibility or to discuss ways to detect if a child has been abused; she further informed the officers that it was their responsibility to determine whether Nicole was abused. N.T., supra, at 76-77.
Yet, Dr. Cohen attended several preliminary hearings related to the criminal proceedings against the Althauses and testified under oath that she believed that Nicole had been abused. Id. at 197. At Juvenile Court, she testified that Nicole's continued placement in foster care with Zappa was appropriate, despite Dr. Axelson's concern that Nicole's relationship with Zappa was unhealthy. N.T., November 22, 1994, at 80-82; December 5, 1994, at 76-77. Dr. Cohen explained her presence at the criminal proceedings stating that therapeutic treatment extended to providing emotional support to Nicole while she testified to matters regarding her abuse despite Dr. Cohen's knowledge that parts of Nicole's testimony at these proceedings were untrue. N.T., December 12, 1994, at 72.
When the criminal case against Nicole's parents came before the Honorable Robert E. Dauer, Judge Dauer ordered, over Dr. Cohen's objection, an independent psychiatric examination of Nicole. The prosecution and the Althauses' counsel agreed to retain Dr. Marshall Schecter.
Dr. Schecter retained two additional psychologists, and psychological testing was performed on Nicole, Richard and Renee Althaus. Dr. Schecter interviewed Nicole, Richard, Renee, Dr. Cohen and numerous health care professionals who had provided care to Nicole. He spoke to Nicole's grandmother, her brother, and Renee's therapist, Dr. Schoor-Ribera. Dr. Schecter reviewed all of Nicole's scholastic records and writings, and spoke with her at great length. Based on his extensive evaluation of Nicole, Dr. Schecter testified at the hearing that, in his opinion, Nicole suffered from a borderline personality disorder. He stated that he did not believe Nicole was ever abused and that her allegations of abuse stemmed from Nicole's inability to distinguish fact from fantasy. Dr. Schecter further testified that Nicole's inability to distinguish truth from fantasy rendered her incompetent to testify.
Dr. Cohen also testified at Nicole's competency hearing. Initially, she stated that, based on her therapeutic treatment of Nicole, she was in a better position than Dr. Schecter to assess Nicole's competence. Id. at 106. During cross-examination, however, Dr. Cohen conceded that many of Nicole's allegations were untrue, and that, at times, Nicole could not distinguish fact from fantasy. When Judge Dauer informed Dr. Cohen that the ability to distinguish fact from fantasy was a condition precedent to testifying under oath, Dr. Cohen advised Nicole not to testify. Consequently, Nicole did not testify and the Commonwealth withdrew the criminal charges filed against the Althauses.
The Althauses and their daughter Nicole then brought the present negligence action against Dr. Cohen and WPIC, on the theory that Dr. Cohen negligently diagnosed and treated Nicole and that this negligence exacerbated Nicole's undiagnosed borderline personality disorder. The Althauses further contended that Dr. Cohen owed them a duty of care because of her awareness that many of Nicole's allegations could not be true and because of her knowledge that these allegations were the basis of the criminal proceedings against them. The case was submitted to a jury, which returned verdicts in favor of both Nicole...
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