Smits v. Park Nicollet Health Servs.
| Decision Date | 07 September 2022 |
| Docket Number | A20-0711 |
| Court | Minnesota Supreme Court |
| Parties | David SMITS, AS TRUSTEE FOR the next of kin for Brian SHORT, Karen Short, Madison Short, Cole Short, Brooklyn Short, Respondent, v. PARK NICOLLET HEALTH SERVICES, et al., Appellants. |
Court of Appeals Office of Appellate Courts
Ronald J. Schutz, Patrick M. Arenz, Brenda L. Joly, Robins Kaplan LLP, Minneapolis, Minnesota; and
Marc R. Stanley, Scott Kitner, Stanley Law Group, Dallas, Texas for respondent.
Aaron D. Van Oort, Emily Zambrana, Hannah M. Leiendecker, Faegre Drinker Biddle & Reath LLP, Minneapolis, Minnesota; and
Mark A. Solheim, Anthony J. Novak, Kevin T. McCarthy, Larson King LLP, Saint Paul, Minnesota, for appellants.
Mark R. Bradford, Bassford Remele, P.A., Minneapolis, Minnesota for amici curiae American Medical Association, Minnesota Medical Association, and Minnesota Hospital Association.
Christopher Kubacki, Kubacki Law PLLC, Treasure Island, Florida, for amicus curiae Brady United Against Gun Violence.
James W. Balmer, Falsani, Balmer, Peterson & Balmer, Duluth, Minnesota, for amici curiae David Healy, M.D., DataBasedMedicine, WoodyMatters, & Kim Witczak.
Brock J. Specht, Robert L. Schug, Nichols Kaster, PLLP, Minneapolis, Minnesota; and
Jessie B. Mishkin, Sarah M. Sternlieb, Weil, Gotshal & Manges LLP, New York, New York, for amici curiae Everytown for Gun Safety Support Fund and Battered Women's Justice Project.
Matthew J. Barber, Schwebel, Goetz & Sieben, PA, Minneapolis, Minnesota, for amici curiae Frederic G. Reamer, Ph.D, and Ofer Zur, Ph.D.
Patrick Stoneking, Jeff Anderson & Associates PA, Saint Paul, Minnesota, for amicus curiae Minnesota Association for Justice.
Dyan J. Ebert, Steven R. Schwegman, Ryan L. Paukert, Quinlivan & Hughes, PA, Saint Cloud, Minnesota; and
Richard J. Thomas, Burke & Thomas, PLLP, Saint Paul, Minnesota, for amicus curiae Minnesota Defense Lawyers Association.
Christopher W. Madel, Matthew J.M. Pelikan, Madel PA, Minneapolis, Minnesota, for amicus curiae Scholars Regarding Mental Health Care and Harm to Family and Community.
Shaun D. Redford, Olson, Redford & Wahlberg, PA, Edina, Minnesota, for amicus curiae Scientists and Clinicians for Effective and Ethical Mental Health Treatments.
1. Healthcare providers have a duty to exercise the degree of skill and care possessed and exercised by practitioners engaged in the same type of practice under like circumstances; a patient committing suicide does not relieve a mental healthcare provider of this duty.
2. A mental healthcare provider's duty of care to its patient does not extend to uninvolved family members, and a patient's violence against his family is not foreseeable when the patient made no violent threats, had no history of violent action, repeatedly denied suicidal ideation, was rational and planning for the future, and consistently referenced others only in a positive and supportive fashion.
Affirmed in part, reversed in part, and remanded.
OPINION & DISSENT [1]
After receiving outpatient treatment for anxiety and depression for approximately 3 months, Brian Short purchased a shotgun and killed his wife, his three children, and then himself. Respondent, the trustee for the next of kin of the five Short family members, brought a wrongful death action against appellants, the mental healthcare providers, alleging that they had provided negligent care. The district court granted summary judgment to the mental healthcare provider and dismissed the action, concluding that it did not have a duty to protect or control Brian or his wife and children in the absence of a custodial "special relationship" or foreseeability of harm. The court of appeals reversed and remanded for trial, holding that the mental healthcare provider owed a duty of care to Brian that was not negated by his suicide, and genuine issues of material fact existed as to whether the provider's conduct created a foreseeable risk to Brian's wife and children. We affirm with respect to the wrongful death action on behalf of Brian, see Part I infra at 13- 19, holding that a mental healthcare provider owes a duty of reasonable care to its patient, which is not negated by a lack of total control over the patient. We reverse with respect to Brian's wife and children, see Part II of the opinion of Justice Anderson, infra at 36-44, holding that the harm to the family members was outside the scope of the duty of care and unforeseeable as a matter of law.
This court case arose from an undeniable tragedy. In 2015 Brian[2] was 45 years old. He was married and had three children, Madison, Cole, and Brooklyn. Brian had been a registered nurse for several years, and then founded a web business related to nursing. This business was successful, and Brian hired several employees. In summer 2015, Brian sought treatment for anxiety and depression from appellants Park Nicollet Health Services, Park Nicollet Clinic, Park Nicollet Methodist Hospital, Park Nicollet Enterprises, and Group Health Plan, Inc. d/b/a HealthPartners Medical Groups (collectively Park Nicollet). In early September 2015, Brian killed his wife and his three teenage children, and then killed himself.
Brian first sought treatment from a Park Nicollet urgent care clinic on June 16, 2015. He complained of "tightness" or "pressure" in his chest. He also reported some difficulty sleeping. He attributed these symptoms to work-related stress stemming from financial difficulties at his business. But he also had a history of minor heart issues and said that he wanted to confirm that his heart condition was not returning. Brian saw a physician assistant, who concluded that the symptoms were caused by anxiety. Brian had not been previously treated for anxiety or depression and reported no history of psychological issues.
He also stated that his appetite was normal and denied any "suicidal or homicidal ideations." The physician assistant prescribed Xanax for his anxiety.
Two days later Brian saw his primary care physician at a different Park Nicollet clinic. He stated that his "mood [had] been a little bit down here over the last 2 or 3 weeks" and reported recent weight loss of 20 or 30 pounds. Brian's vital signs were normal, and he denied any suicidal ideation. Brian's physician prescribed him the antidepressant Zoloft at 50 milligrams per day. The physician told Brian to come back in 5 weeks if his symptoms had not resolved.
Brian returned to the Park Nicollet urgent care clinic 9 days later on June 27. Brian reported further difficulty sleeping; he believed that the Xanax was initially helping but wore off too quickly and stated that the Zoloft was not yet helping.[3] He was again asked about, and again denied, suicidal ideation. Brian was prescribed Ativan, a short-term anxiety medication, and Ambien to help him sleep.
Brian saw his primary care physician again on July 6 and reported continued anxiety and occasional panic attacks. He had lost an additional 11 pounds since his visit on June 18. His physician increased the dosage of Zoloft from 50 to 100 milligrams per day. The physician also changed Brian's sleep medication from Ambien to Trazodone out of concern for possible interactions between Ambien and Ativan. The physician referred Brian to mental health counseling.
On July 15, Brian received a diagnostic assessment from Park Nicollet's psychiatry department, where he saw an Advanced Practice Registered Nurse (APRN). Brian reported "extreme anxiety" about his business and his expenses. He also reported low energy and that he was feeling "irritable, overwhelmed and hopeless." He admitted some idle thoughts of suicide but specifically denied "any plan or intent" and said that he had never made any suicide attempts. The APRN administered a standardized patient assessment called a PHQ-9,[4] on which Brian scored 23 out of 27-indicating severe depression. The APRN diagnosed Brian with "[m]ajor depression, single episode, severe, without psychosis." However, the APRN concluded that it was too early in the treatment to assess Brian's Zoloft dose. The APRN referred Brian to therapy and told him to return in 4 weeks "or sooner if needed."
Brian attended therapy with a Park Nicollet-employed licensed social worker on July 16. He continued to report feeling anxious and depressed. The social worker administered another PHQ-9. Brian again scored 23, responded, "several days," to a question on thoughts of suicide and self-harm, and handwrote next to the question that he "wouldn't say several days but a few." Brian was also separately asked about, and denied having, any "suicidal/homicidal ideation, intent, or plan." The social worker set a treatment goal of decreasing Brian's PHQ-9 score to "3 or below for 3 consecutive appointments."
On July 28, Brian called Park Nicollet and left a message, stating that his medications were "not helping to decrease his anxiety." The APRN directed another nurse to increase Brian's Zoloft dose from 100 to 150 milligrams per day. The nurse told Brian to increase his dose over the phone.
Brian returned to Park Nicollet for two more therapy sessions with the same social worker on August 4 and 12. He continued to report anxiety and depression, though he denied suicidal/homicidal "ideation, intent, or plan." Brian was not administered a PHQ-9 at either the August 4 or August 12 appointments. The social worker did not administer Brian a PHQ-9 on August 4 because Brian arrived late for his appointment, and the social worker did not record why Brian was not given a PHQ-9 on August 12.
On August 14, Brian saw...
To continue reading
Request your trial