Tarasoff rule

DEFINITION: Duty of mental health professionals to warn third parties known to be the subjects of threats of injury or death by patients.

SIGNIFICANCE: When California’s highest court imposed liability on mental health professionals for serious injuries to third parties known to be the subject of threats by patients, the court held that the public interest in protecting individual safety overrides the maintenance of confidentiality between therapist and patient.

Prior to the 1976 decision of the California Supreme Court in Tarasoff v. Regents of the University of California, no law in the United States recognized a therapist’s duty toward individuals with whom the therapist had no formal relationship. A therapist had discretion concerning any warning to a third party about a dangerous individual. Maintaining confidentiality within the confines of the therapist-patient relationship was paramount. Following the court’s ruling in Tarasoff, mental health professionals were charged with the responsibility to take reasonable steps to prevent violence threatened by their patients by warning third parties as well as the appropriate authorities.

Because the court failed to provide guidelines concerning when warnings would be required and left it up to therapists to determine whether patients would in fact act on their threats, the duty imposed on therapists was subject to much conjecture and speculation. When the decision was first handed down, opponents predicted that it would lead to unwarranted hospitalizations and ineffective calls to and potential victims. They also suggested that therapists might become wary and avoid potentially violent patients, who in turn would be reluctant to talk with therapists about their violent thoughts. Several decades have demonstrated that those fears were unrealistic, however.

Subsequent case law has also clarified a workable solution concerning when a therapist is required to issue a warning to a third party. When a patient expresses a threat of serious harm to an identifiable victim, the legal obligation to protect the intended victim against such danger is imposed on the therapist. That duty may require the therapist to take one or more steps, such as warning the intended victim or others of the danger, notifying law-enforcement authorities, and taking whatever additional actions are necessary, depending on the nature of the case.

Facts of the Case

Prosenjit Poddar was a graduate student from India, studying at the University of California at Berkeley. In the fall of 1968, he met Tatiana (Tanya) Tarasoff at a folk-dancing class. They saw each other weekly throughout that fall, and on New Year’s Eve, Tarasoff kissed Poddar. He interpreted this kiss to indicate the existence of a serious relationship between them. When Tarasoff learned of Poddar’s feelings, she told him of her involvement with other men and indicated that she was not interested in entering into an intimate relationship with him. In part because of their different cultures, Poddar did not understand Tarasoff’s explanation and underwent a severe emotional crisis. He spoke to a friend about his love for Tarasoff and his uncontrollable desire to kill her.

During the summer of 1969, Tarasoff went to Brazil. After she left, Poddar began to improve and, at a friend’s suggestion, sought help from the university’s health service. He began psychotherapy under the care of a staff psychologist, Dr. Lawrence Moore. During his ninth session with Moore, Poddar confided that he was going to kill Tarasoff when she returned from Brazil. Two days later, Moore personally notified campus police officers that Poddar was capable of harming himself or others; he also wrote a letter to the chief of the campus police in which he stated that Poddar was an acute and severe paranoid schizophrenic and a danger to himself and others. The campus police took Poddar into custody, but they released him when he promised to change his attitude and stay away from Tarasoff. Poddar stopped his therapy.

When Tarasoff returned from Brazil in October 1969, Poddar continued to stalk her. On October 27, armed with a pellet gun and a kitchen knife, Poddar shot Tarasoff and repeatedly and fatally stabbed her. Afterward, he called the police, confessed, and asked to be handcuffed. Moore’s diagnosis of Poddar was confirmed the following day.

The Decision

Poddar was charged with Tarasoff’s murder, and he pleaded not guilty by reason of insanity. A convicted Poddar of second-degree murder, and he appealed on multiple grounds. The appellate court focused on jury instruction errors made in the trial court and reduced Poddar’s to manslaughter. Two years later, the California Supreme Court vacated the judgment, held that the jury instruction error was prejudicial, and remanded the case for retrial. Poddar was not retried. Rather than conduct another lengthy trial, the state released Poddar on the condition that he leave for India and not return to the United States. He did so; he later married in India.

Tarasoff’s parents filed a wrongful-death civil action simultaneously against the university’s police department, the Regents of the University of California, and the university’s health service for failing to warn their daughter about Poddar’s desire to kill her. At trial, the case was dismissed because of the absence of a cause of action (legal reason for suing) owing to the physician-patient privilege of confidentiality. Specifically, the court ruled that a physician has a duty only to the patient, not to third parties; therefore, no duty was owed to Tarasoff.

The intermediate appellate court upheld the trial court’s decision, but the California Supreme Court reversed, holding that the case stated a cause of action and must be heard. The Supreme Court reasoned that the therapist has a duty to use reasonable care to give threatened persons whatever warnings are necessary to avert foreseeable danger. The duty extends from the patient to the intended victim. Addressing the defendants’ assertion that a warning constitutes a breach of the trust inherent in confidential communications, the court recognized the public interest in supporting effective treatment of mental illness and protecting patients’ right to privacy and confidentiality but concluded that the public interest in safety from violent assault outweighs these considerations, stating, “The protective privilege ends where the public peril begins.”

The initial California Supreme Court decision in 1974 held that the campus police could be found liable for their failure to warn Tarasoff, but at the rehearing in 1976, the police were released from all liability. The holdings with respect to the psychotherapists were essentially the same in both cases and were predicated on the same arguments. The second decision provided therapists greater latitude to “protect” intended victims rather than to “warn” them. It should be noted that the case was never decided on the merits because it was settled for an undisclosed sum of money.

In evaluating the imposition of liability, the California Supreme Court noted the discretion given to psychiatrists to use their best judgment in determining whether patients are dangerous. Courts will generally defer to this discretion. In cases in which patients verbally demonstrate intent to harm others, however, psychiatrists are liable for injuries that arise from patients’ carrying out their threats.

Tarasoff’s Impact

The court’s ruling in Tarasoff expanded the legal concepts of duty and foreseeability. Despite initial concerns regarding therapists’ inability to predict violent behavior accurately and the effect of breach of confidentiality, these matters have not had the adverse impacts initially feared and predicted. Ultimately, the Tarasoff case stimulated greater awareness of violent patients’ potential for carrying out such behavior. That, in turn, stimulated closer scrutiny and better documentation concerning this issue.

Since the Tarasoff decision, other interesting related questions have arisen, such as whether clergy who engage in pastoral counseling activities have a duty to protect third parties. Because in pastoral counseling there is little or no “control” over the penitent as there is over the patient in psychotherapy, the legal arguments used in Tarasoff do not apply to this situation. Scholars feel, however, that most members of the clergy in their discretion will take necessary steps to notify either potential victims or the appropriate authorities.

The Tarasoff rule imposes civil liability. The question of criminal liability has not been studied extensively, but one scholar has argued that the breach of the duty to warn should lead to criminal liability for the committed by the patient. Furthermore, the duty was reformulated as a duty to treat dangerousness, not as a duty to prevent harm to third parties. It should be noted, however, that no has prosecuted a therapist criminally for a violation of the Tarasoff duty to warn.

Although the Tarasoff rule itself applied only in California, other states passed their own versions of the statute. As of 2022, twenty-three states had similar rules inscribed into state law; another ten states had such rules as part of their common law, legal precedents based on court decisions rather than legislatively passed law. Eleven states left the decision to warn up to the psychiatrist, while six states had no Tarasoff-style rules. In some cases, the legal statutes lessened the “duty to warn” aspect of the rule and put the focus on a “duty to protect.” In such cases, the therapist does not have to warn the target of violence but can protect the individual by reporting the threats to police or having the potentially violent patient hospitalized.

Bibliography

Appelbaum, Paul S. Almost a Revolution: Mental Health Law and the Limits of Change. New York: Oxford University Press, 1994.

Beis, Edward B. Mental Health and the Law. New York: Aspen, 1984.

Blum, Deborah. Bad Karma: A True Story of Obsession and Murder. New York: Atheneum, 1986.

Buckner, Fillmore, and Marvin Firestone. “’Where the Public Peril Begins’: Twenty-five Years After Tarasoff.” Journal of Legal Medicine 21, no. 2 (2000): 187-222.

Frost, Lynda E., and Richard J. Bonnie, eds. The Evolution of Mental Health Law. Washington, D.C.: American Psychological Association, 2001.

Gorshkalova, Olga, and Sunil Munakomi. "Duty to Warn." StatPearls, 28 Aug. 2023, www.ncbi.nlm.nih.gov/books/NBK542236/. Accessed 19 Aug. 2024.

Hermann, Donald H. J. Mental Health and Disability Law in a Nutshell. St. Paul, Minn.: West, 1997.

Slobogin, Christopher. “Tarasoff as a Duty to Treat: Insights from Criminal Law.” University of Cincinnati Law Review 75 (2007): 101-117.