Duty to Protect through Duty to Protect through WarningWarning

Emerich v. the Philadelphia Emerich v. the Philadelphia Center for Human Development Center for Human Development

Principle 5: ConfidentialityPrinciple 5: Confidentiality

““This code of ethics does not prohibit a This code of ethics does not prohibit a psychologist from taking reasonable psychologist from taking reasonable measures to avoid harm when a client has measures to avoid harm when a client has expressed a serious threat or intent to kill expressed a serious threat or intent to kill or seriously injure an identified or readily or seriously injure an identified or readily identifiable person or group of people and identifiable person or group of people and when the psychologist determines that the when the psychologist determines that the client is likely to carry out the threat or the client is likely to carry out the threat or the intent of the client.”intent of the client.”

Basic FactsBasic Facts

Gad Joseph participated in psychotherapy Gad Joseph participated in psychotherapy with Mr. Scuderi at PCHDwith Mr. Scuderi at PCHD

Joseph had a history of violence toward Joseph had a history of violence toward his Teresa Hausler, his live-in partnerhis Teresa Hausler, his live-in partner

She broke off the relationship and moved She broke off the relationship and moved to Readingto Reading

Basic FactsBasic Facts

On June 27, 1991, Joseph phoned his On June 27, 1991, Joseph phoned his therapist and advised that he was going to therapist and advised that he was going to kill Ms. Hausler.kill Ms. Hausler.

A session was scheduled at 11 am. At that A session was scheduled at 11 am. At that session, Joseph indicated that he would session, Joseph indicated that he would kill Hausler if she returned to the kill Hausler if she returned to the apartment to collect her belongings.apartment to collect her belongings.

Basic FactsBasic Facts

Mr. Scuderi recommended that Joseph Mr. Scuderi recommended that Joseph voluntarily commit himself. He refused; voluntarily commit himself. He refused; however, he stated that he would not hurt however, he stated that he would not hurt Ms. Hausler. Session ends at noon.Ms. Hausler. Session ends at noon.

At 12:15 pm, Hausler phones Scuderi, At 12:15 pm, Hausler phones Scuderi, explained that she is returning to their explained that she is returning to their apartment. She wanted to know about apartment. She wanted to know about Joseph’s whereabouts.Joseph’s whereabouts.

Basic FactsBasic Facts

Mr. Scuderi instructed Hausler to not to go Mr. Scuderi instructed Hausler to not to go to the apartment and return to Reading.to the apartment and return to Reading.

Pennsylvania Supreme Court Pennsylvania Supreme Court DecisionDecision

Under certain circumstances, a mental Under certain circumstances, a mental health professional has a duty to protect health professional has a duty to protect by warning a potential third-party victimby warning a potential third-party victim

Some specifics from the CourtSome specifics from the Court

1. When the patient has communicated to the 1. When the patient has communicated to the professional, professional, a specific and immediate threat a specific and immediate threat of serious bodily injuryof serious bodily injury against against a specifically a specifically identified or readily identifiable third partyidentified or readily identifiable third party

2. And when the professional determines (or 2. And when the professional determines (or should determine under the standards of the should determine under the standards of the mental health profession) that the patient mental health profession) that the patient presents a serious danger of violence to the presents a serious danger of violence to the third partythird party

Some specifics from the CourtSome specifics from the Court

3. Then the professional 3. Then the professional bears a duty to bears a duty to exercise reasonable care to protect by exercise reasonable care to protect by warning the third party against such warning the third party against such dangerdanger

Lack of clarity in decisionLack of clarity in decision

1. “A specific and immediate threat" of 1. “A specific and immediate threat" of serious bodily injury is not well definedserious bodily injury is not well defined

Temporal issue in playTemporal issue in play

2. “Serious danger of violence" is not well 2. “Serious danger of violence" is not well defined defined

Involves prediction of violenceInvolves prediction of violence

Important points to noteImportant points to note

A careful, thoughtful, and clinically sound A careful, thoughtful, and clinically sound assessment must be conducted in the assessment must be conducted in the appropriate cases to determine whether appropriate cases to determine whether the patient presents a serious danger of the patient presents a serious danger of violence to a third party.violence to a third party.

(Future liability may attach if such an (Future liability may attach if such an assessment is not conducted in an assessment is not conducted in an adequate manner.)adequate manner.)

Important points to noteImportant points to note

The clinician is balancing the need to The clinician is balancing the need to protect others in the community with the protect others in the community with the patient’s right to privacy, which is a patient’s right to privacy, which is a cornerstone of psychotherapy.cornerstone of psychotherapy.

(Future liability may attach if care is not (Future liability may attach if care is not care in breaching confidentiality.)care in breaching confidentiality.)

Helpful HintsHelpful Hints

Conduct a thorough risk assessmentConduct a thorough risk assessment

a. Is the threat immediate?a. Is the threat immediate?

b. Is the victim clearly identifiable?b. Is the victim clearly identifiable?

c. Does this rise to the level of c. Does this rise to the level of serious serious bodily harm or death?bodily harm or death?

d. Not every utterance of violence is d. Not every utterance of violence is a a threat.threat.

e. Evaluate risk factorse. Evaluate risk factors

Helpful HintsHelpful Hints

If the criteria for warning is not met, but If the criteria for warning is not met, but violence remains an issue, it needs to be violence remains an issue, it needs to be addressed in therapyaddressed in therapy

Ongoing focus of treatmentOngoing focus of treatment

Document any strategies, plans, or Document any strategies, plans, or updated evaluationsupdated evaluations

Helpful HintsHelpful Hints

If the criteria are met, then a warning If the criteria are met, then a warning needs to be issued.needs to be issued.

a. Who needs to be warned?

b. How is the warning communicated?

c. How much information is shared?

Helpful HintsHelpful Hints

Documentation is crucial in such Documentation is crucial in such circumstances, whether or not a warning is circumstances, whether or not a warning is issuedissued

Document relevant pointsDocument relevant points

Detail violence assessmentDetail violence assessment

Document any consultationsDocument any consultations

Record the decision-making processRecord the decision-making process

Case ExamplesCase Examples