B.R. v. West

Decision Date28 February 2012
Docket NumberNo. 20110207.,20110207.
Citation2012 UT 11,703 Utah Adv. Rep. 4,275 P.3d 228
PartiesB.R., a minor child, and C.R., a minor child, through their conservator William M. JEFFS, Plaintiffs and Appellants, v. Trina WEST, Hugo Rodier, Pioneer Comprehensive Medical Clinic, and John Does I–X, Defendants and Appellees.
CourtUtah Supreme Court


Allen K. Young, Tyler S. Young, Provo, Jonah Orlofsky, Chicago, IL, for appellants.

Stephen W. Owens, J. Kevin Murphy, Vaun B. Hall, Salt Lake City, Michael K. McKell, Paul McArthur, Provo, for appellees.

Tawni J. Anderson, for amici Utah Medical Association, Utah Psychiatric Association, Utah Hospitals and Health Systems Association, and American Medical Association.Justice LEE, opinion of the Court:

¶ 1 In this case we are asked to determine whether a physician owes nonpatients a duty to exercise reasonable care in the affirmative act of prescribing medications that pose a risk of injury to third parties. We uphold such a duty, while clarifying the nature of the legal analysis relevant to duty in tort, the factors relevant to its evaluation, and its relation to matters of breach and proximate cause.


¶ 2 According to the allegations of the complaint, which we accept as true for purposes of our analysis, David Ragsdale received medical treatment in 2007 from Trina West, a nurse practitioner at Pioneer Comprehensive Medical Clinic in Draper, Utah. Nurse West prescribed Ragsdale at least six medications, including Concerta, Valium, Doxepin, Paxil, pregnenolone, and testosterone. In January 2008, with all of these drugs in his system, Mr. Ragsdale shot and killed his wife, Kristy Ragsdale. Mr. Ragsdale subsequently pled guilty to aggravated murder.

¶ 3 The Ragsdales' young children, who were left parentless, filed suit through their conservator against Nurse West, her consulting physician Dr. Hugo Rodier, and the medical clinic. Plaintiffs alleged negligence in the prescription of the medications that caused Mr. Ragsdale's violent outburst and his wife's death.

¶ 4 Defendants filed a motion to dismiss under rule 12(b)(6) of the Utah Rules of Civil Procedure. The district court granted the motion, concluding that West owed no duty of care to plaintiffs because “no patient-health care provider relationship existed, at the time of the underlying events, between the plaintiffs ... and the defendants.” The court further reasoned that “the non-patient plaintiffs may [not] step into David Ragsdale's shoes to pursue a malpractice lawsuit against the defendants.” Plaintiffs filed this appeal, contending that the district court incorrectly concluded that defendants did not owe a duty of care to the nonpatient plaintiffs. We agree and reverse. 1


¶ 5 As every first-year law student learns, duty is one of four essential elements of a cause of action in tort.2 In negligence cases, a duty is ‘an obligation, to which the law will give recognition and effect, to conform to a particular standard of conduct toward another.’ 3 The question in this case is whether healthcare providers have a legal obligation to nonpatients to exercise reasonable care in prescribing medications that pose a risk of injury to third parties. Our cases have identified several factors relevant to determining whether a defendant owes a duty to a plaintiff, including: (1) whether the defendant's allegedly tortious conduct consists of an affirmative act or merely an omission, e.g., Webb v. Univ. of Utah, 2005 UT 80, ¶ 10, 125 P.3d 906; (2) the legal relationship of the parties, id.; (3) the foreseeability or likelihood of injury, e.g., AMS Salt Indus., Inc. v. Magnesium Corp. of Am., 942 P.2d 315, 321 (Utah 1997); (4) “public policy as to which party can best bear the loss occasioned by the injury,” Normandeau v. Hanson Equip., Inc., 2009 UT 44, ¶ 19, 215 P.3d 152; and (5) “other general policy considerations,” id. Not every factor is created equal, however. As we explain below, some factors are featured heavily in certain types of cases, while other factors play a less important, or different, role. The parties in this case focus heavily on the first two factors. We address those factors in Part A and explain that the legal-relationship factor is typically a “plus” factor—used to impose a duty where one would otherwise not exist, such as where the act complained of is merely an omission. In Part B, we discuss the final three factors and explain that these factors are typically “minus” factors—used to eliminate a duty that would otherwise exist. Applying these factors, we conclude that defendants do owe a duty to plaintiffs in this case.


¶ 6 A central point of the parties' disagreement in this case is whether a healthcare provider's duty requires the existence of a “special legal relationship.” Defendants contend that healthcare providers owe no duty to a nonpatient who has been injured by a patient unless the patient has a special relationship with the provider—such as where the provider has custody or control of the patient, or where the provider is on notice that the patient is uniquely dangerous to specified third parties. Plaintiffs, for their part, insist that a special relationship is required “only where a claim is based on an omission or a failure to act.” According to plaintiffs, the “most critical fact in this case is that Defendants' negligence consists of affirmative conduct,” because affirmative acts are typically associated with a duty of care.

¶ 7 We side with the plaintiffs. The long-recognized distinction between acts and omissions-or misfeasance and nonfeasance—makes a critical difference and is perhaps the most fundamental factor courts consider when evaluating duty. 4 Acts of misfeasance, or “active misconduct working positive injury to others,” typically carry a duty of care.5 Nonfeasance—“passive inaction, a failure to take positive steps to benefit others, or to protect them from harm not created by any wrongful act of the defendant—by contrast, generally implicates a duty only in cases of special legal relationships. 6 The first two duty factors, then, are interrelated.

¶ 8 Special relationships “arise when one assumes responsibility for another's safety or deprives another of his or her normal opportunities for self-protection.” Webb, 2005 UT 80, ¶ 10, 125 P.3d 906 (internal quotation marks omitted). Traditional examples include “common carrier to its passenger, innkeeper and guest, landowner and invitees to his land, and one who takes custody of another.” Id. (citing Restatement (Second) of Torts § 314A (1965)).

¶ 9 We previously clarified the relationship between the nonfeasance and special-relationship factors in Webb, 2005 UT 80, 125 P.3d 906. There we explained:

[T]he distinction between acts and omissions is central to assessing whether a duty is owed [to] a plaintiff. In almost every instance, an act carries with it a potential duty and resulting legal accountability for that act. By contrast, an omission or failure to act can generally give rise to liability only in the presence of some external circumstance—a special relationship.

Id. ¶ 10 (citations omitted). A special legal relationship between the parties thus acts as a duty-enhancing, “plus” factor. Even in nonfeasance cases, where a bystander typically would owe no duty to prevent harm, a special legal relationship gives rise to such a duty.7

¶ 10 Webb itself was a suit against a government entity which, for policy reasons, is a rare instance where an affirmative act does not presumptively give rise to a duty. Id. ¶ 11. Under Webb, a plaintiff must demonstrate a special relationship with a government actor even if the injury arises from an affirmative act, rather than an omission. 8 Thus, Webb held that, because no special relationship existed, the University of Utah did not owe a duty to a student who allegedly was directed by a university employee to walk on an icy sidewalk. Id. ¶¶ 3, 16, 27. Outside the government context, however, a special relationship is not typically required to sustain a duty of care to those who could foreseeably be injured by the defendant's affirmative acts. Id. ¶ 10.9

¶ 11 The cases cited by defendants are not to the contrary. They require a special relationship only as to nonfeasance or acts of government defendants. See Rollins v. Petersen, 813 P.2d 1156 (Utah 1991); Higgins v. Salt Lake Cnty., 855 P.2d 231 (Utah 1993); Wilson v. Valley Mental Health, 969 P.2d 416 (Utah 1998). Rollins, for example, was a straightforward nonfeasance case: Plaintiff alleged negligence in a secure mental health facility's failure to prevent a patient from causing a car accident—“in allowing [the patient] to walk away from the facility, and in not adequately instituting its own AWOL procedures to recover him.” Rollins, 813 P.2d at 1158. In refusing to find a duty of care, the court held that no special relationship existed between the hospital and the patient, and therefore the hospital owed no duty to the plaintiff to protect against harm caused by the patient. Id. at 1162.

¶ 12 Notably, in Rollins the plaintiff did not allege any affirmative misconduct by the hospital—just that the hospital had failed to prevent the patient from engaging in harmful conduct. Thus, the court analyzed duty under the Restatement (Second) of Torts sections 314–20, entitled “Duties of Affirmative Action.” Rollins, 813 P.2d at 1159. Those sections are a restatement of and elaboration on the principle we discussed in Webb, 2005 UT 80, ¶ 10, 125 P.3d 906, that “an omission or failure to act can generally give rise to liability only in the presence of some external circumstance—a special relationship.” 10

¶ 13 Higgins is similar. When a mentally ill hospital outpatient stabbed a young girl, her parents alleged that the hospital owed a duty to the plaintiff to “control and/or to treat” the patient to prevent the patient from engaging in violent conduct. 855 P.2d at 234. The court again applied section 315 of the Restatement (Second),...

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