Hutchinson v. Patel

• Decision Date: 23 May 1994
• Citation: 637 So.2d 415
• Parties: 93-2156 La
• Court: Louisiana Supreme Court

Page 415

637 So.2d 415

93-2156 La. 5/23/94, 62 USLW 2778

Nelita M. HUTCHINSON v. Navin P. PATEL, M.D., et al.

No. 93-C-2156.

Supreme Court of Louisiana.

May 23, 1994.

Donald T.W. Phelps, Jay B. Mitchell, Daniel A. Reed, A. Edward Hardin, Baton Rouge, for applicant.

Richard M. Upton, Baton Rouge, for respondent.

Jane E. Booth, Metairie, for amicus curiae Louisiana Psychiatric Ass'n, Louisiana State Medical Soc.

[93-2156 La. 1] KIMBALL, Justice. ^*

We granted certiorari in this case to consider whether the Louisiana Medical Malpractice Act ¹ governs a plaintiff's claim against a hospital and a psychiatrist for their alleged failure to warn or take reasonable precautions to protect the plaintiff against a threat of physical violence communicated to the psychiatrist by a patient. After construing the Act's definition of "malpractice" in light of its context, the text of the Act as a whole, the purpose of the Act, and other laws on the same subject matter, we conclude the Act applies exclusively to claims arising from injuries to or death of a patient where such claims are brought by the patients themselves, their representatives on the patient's behalf, or other persons with claims arising from injuries to or death of a patient. Finding the plaintiff's claim does not arise from injury to or death of a patient, we hold the Medical Malpractice Act does not govern her claim.

On September 27, 1990, Thomas Hutchinson, plaintiff's husband, voluntarily presented himself to Parkland Hospital in Baton Rouge seeking psychiatric treatment after an incident in which he had quarrelled violently with plaintiff and threatened her life. The hospital admitted Mr. Hutchinson under the care of Navin P. Patel, M.D., a licensed psychiatrist with privileges at the hospital. After treating Mr. Hutchinson with medication and psychiatric therapy, Dr. Patel released Mr. Hutchinson from Parkland on October 10, 1990.

[93-2156 La. 2] On November 19, 1990, Mr. Hutchinson persuaded plaintiff to meet him in the parking lot of the apartment complex where they had formerly resided. During this meeting, Mr. Hutchinson shot plaintiff, permanently paralyzing her from the waist down. Mr. Hutchinson then turned the gun on himself and committed suicide.

Plaintiff filed suit in district court alleging Dr. Patel and Parkland Hospital breached their duty to warn her or to take other reasonable precautions to protect her against Mr. Hutchinson's violent behavior. In response, Dr. Patel filed an exception of prematurity seeking dismissal of the district court action on the grounds that the Louisiana Medical Malpractice Act requires plaintiff's claim to be submitted to a medical review panel prior to the filing of a civil action.

The trial court denied Dr. Patel's exception of prematurity. The Louisiana First Circuit Court of Appeal affirmed, ² finding plaintiff's claim is not covered by the Medical Malpractice Act because it "does not involve the medical care or treatment of a patient." We granted Dr. Patel's writ application ³ and now affirm.

The duty of a psychotherapist to warn third parties of a threat of violence communicated by a psychiatric patient was first recognized by the California Supreme Court in Tarasoff v. Regents of the University of California, 17 Cal.3d 425, 131 Cal.Rptr. 14, 551 P.2d 334 (1976). In Tarasoff, 131 Cal.Rptr. at 25, 551 P.2d at 345, the court held that because a psychotherapist stands in a special relationship with a patient, the therapist has a duty first to exercise "that reasonable degree of skill, knowledge, and care ordinarily possessed and exercised by members of [that professional specialty] under similar circumstances" in predicting whether the patient poses a serious danger to others, and secondly "to exercise reasonable care to protect the foreseeable victim of that danger."

In Louisiana, the legislature recognized the existence of a therapist's "duty to warn" under Louisiana law by enacting La.R.S. 9:2800.2. At the time of plaintiff's injuries, the statute provided:

§ 2800.2. Psychologist and psychiatrist; limitation of liability

A. When a patient has communicated an immediate threat of physical violence against a clearly identified victim or victims, coupled with the apparent intent and ability to carry out that threat, a psychologist, licensed under R.S. 37:2351-2369, or a psychiatrist, licensed under R.S. 37:1261-1291, treating such patient and exercising reasonable professional judgment, shall not be liable for a breach of confidentiality for warning of such threat or taking precautions to [93-2156 La. 3] provide protection from the patient's violent behavior.

B. A psychologist's or psychiatrist's duty to warn or to take reasonable precautions to provide protection from violent behavior arises only under the circumstance specified in Subsection A of this Section. This duty shall be discharged by the psychologist or psychiatrist if he makes a reasonable effort to communicate the immediate threat to the potential victim or victims and to notify law enforcement authorities in the vicinity of the patient's or potential victim's residence.

C. No liability or cause of action shall arise against any psychologist or any psychiatrist based on an invasion of privacy or breach of confidentiality for any confidence disclosed to a third party in an effort to discharge the duty arising under Subsection A of this Section. ⁴

In the present case, we must decide whether the Louisiana Medical Malpractice Act governs plaintiff's "Tarasoff claim" against Parkland Hospital and Dr. Patel.

The Louisiana Legislature enacted the Medical Malpractice Act in 1975 in response to a perceived medical malpractice insurance "crisis." Butler v. Flint Goodrich Hosp., 607 So.2d 517, 521 (La.1992); Galloway v. Baton Rouge Gen. Hosp., 602 So.2d 1003, 1005 (La.1992); Everett v. Goldman, 359 So.2d 1256, 1261 (La.1978). The legislature intended the Act to reduce or stabilize medical malpractice insurance rates and to assure the availability of affordable medical services to the public. See id. To those ends, the Act confers upon qualified health care providers ⁵ two principal advantages in actions against them for malpractice. First, the [93-2156 La. 4] liability of a qualified health care provider for all malpractice claims for injuries to or death of any one patient may not exceed $100,000, and the total amount recoverable from all defendants and the Patient's Compensation Fund ⁶ for all malpractice claims for injuries to or death of any one patient, exclusive of future medical care and related benefits, may not exceed $500,000 plus interest and costs. La.R.S. 40:1299.42(B). Second, no action for malpractice against a qualified health care provider or his or her insurer may be commenced in a court of law before the complaint has been presented to a medical review panel and the panel has rendered its expert opinion on the merits of the complaint, unless the parties agree to waive this requirement. La.R.S. 40:1299.47.

The Act applies solely to claims "arising from medical malpractice." La.R.S. 40:1299.41(I); see Sewell v. Doctors Hosp., 600 So.2d 577, 578 (La.1992). The Act defines "malpractice" as follows:

(8) "Malpractice" means any unintentional tort or any breach of contract based on health care or professional services rendered, or which should have been rendered, by a health care provider, to a patient, including failure to render services timely and the handling of a patient, including loading and unloading of a patient, and also includes all legal responsibility of a health care provider arising from defects in blood, tissue, transplants, drugs and medicines, or from defects in or failures of prosthetic devices, implanted in or used on or in the person of a patient.

La.R.S. 40:1299.41(A) (emphasis added). The Act further defines "patient," "tort," and "health care" as follows:

(3) "Patient" means a natural person who receives or should have received health care from a licensed health care provider, under a contract, express or implied.

....

(7) "Tort" means any breach of duty or any negligent act or omission proximately causing injury or damage to another. The standard of care required of every health care provider, except a hospital, in rendering professional services or health care to a patient, shall be to exercise that degree of skill ordinarily employed, under similar circumstances, by the members of his profession in good standing in the same community or locality, and to use reasonable care and diligence, along with his best judgment, in the application of his skill.

....

(9) "Health care" means any act, or treatment performed or furnished, or which should have been performed or furnished, by any health care provider for, to, or on behalf of a patient during the patient's medical care, treatment or confinement.

La.R.S. 40:1299.41(A).

[93-2156 La. 5] Unquestionably, Mr. Hutchinson was Dr. Patel's "patient" ⁷ to whom Dr. Patel rendered "health care," and Dr. Patel's alleged breach of his duty to warn or take reasonable precautions to protect plaintiff constitutes an unintentional "tort," all as defined in the Act. The question is whether Dr. Patel's alleged tortious conduct in failing to warn or take reasonable precautions to protect plaintiff was "based on" his treatment or failure to treat his patient, Mr. Hutchinson, within the meaning of the Act's definition of "malpractice." If so, then the Act governs plaintiff's claim and her suit is premature until a medical review panel has rendered its expert opinion on the merits of the complaint. Otherwise, plaintiff's suit may proceed in district court as an ordinary negligence action.

This court has noted on numerous occasions that because the Medical Malpractice Act limits the liability of health care providers in derogation of the general rights of tort victims, any ambiguities in the Act should be strictly construed against coverage. Branch v....