Doctor’s Duty to Potential Targets

Doctor’s Duty to Potential Targets

Doctor’s Duty to Potential Targets

In the case of Sinoracki v. The Children’s Service Center of Wyoming Valley, 2023 PA Super 170 (September 19, 2023), the Superior Court determined that healthcare professionals caring for a homicidal patient did not have a duty to protect the victim (patient’s neighbor) from harm, thereby dismissing the negligence and wrongful death claims.

Z.H. had a brain abnormality that caused him to engage in erratic and aggressive behavior, which included substance abuse, school suspensions, self-injurious behavior, and physical assaults. He came under the care of Dr. Khan at the Children’s Service Center. Dr. Khan was aware of Z.H.’s substance abuse and noted that Z.H. had anger outbursts at home and was destructive and combative. Dr. Khan frequently saw Z.H., and managed his medications throughout his treatment with CSC.

Notwithstanding Dr. Khan’s treatment, Z.H. began to display suicidal ideations, self-injurious conduct, increased and severe aggression, paranoia, and anger. Z.H. threatened to kill his father, therefore his parents called the police, who forcibly restrained Z.H. and brought him to Geisinger Medical Center for evaluation, bagged with a “spit hood” and handcuffed due to his aggressive behavior. Z.H. was transferred to KidsPeace for homicidal ideations and paranoia. While there, the psychiatric evaluation revealed that Z.H. had punched his brother and had anger problems, and had markedly impaired insight and judgment. Z.H. was at KidsPeace a short time before he was determined no longer to be a threat to others, and discharged back to home.

Shortly following discharge from KidsPeace, Z.H. was riding in the front passenger’s seat of his mother’s vehicle when he grabbed the steering wheel and drove into oncoming traffic, crashing the car because he believed someone was watching him. Z.H. was readmitted to KidsPeace that same day. While Z.H. was at KidsPeace, his social worker noted that Z.H. was struggling to adjust to the program and demonstrated noncompliance with following basic rules and expectations. During a visit with his parents, Z.H. became angry and threw a chair against a wall and broke a toilet paper dispenser. Z.H. continued to display worsening behavior and limited signs of improvement for the duration of his fourteen-day admission; however, Z.H. was ultimately discharged back to home.

On the night of his discharge, Z.H. stayed awake all night and sat on his front porch due to paranoia that someone was going to hurt him or his family. Z.H.’s parents continuously called KidsPeace and CSC, advising them of Z.H.’s continued behavior. Z.H.’s mother took him to CSC to see Dr. Khan, who knew the details of Z.H.’s history, and maintained the established plan for therapeutic intervention when his mood deteriorated. Following this visit, Z.H.’s parents continued to call KidsPeace and CSC, including CSC’s crisis intervention services. A counselor with CSC provided several options on how to address Z.H. The counselor advised that she would come to the house to respond to the crisis the following day. At no time did CSC or KidsPeace consider or pursue involuntary commitment of Z.H. Days later, Z.H.’s father saw his son leave the front porch and driveway moments before Z.H. entered the Sinoracki family’s home and violently assaulted Bobbi Jo, Megan, and David Sinoracki with a kitchen steak knife. Shortly thereafter, Z.H.’s father entered the Sinoracki family’s home and forcibly restrained Z.H. on a chair in the living room. The police responded to the scene and took Z.H. into custody. Ultimately, David Sinoracki succumbed to his injuries.

Bobbi Jo Sinoracki initiated a negligence and wrongful death action against the Defendants, alleging that the Defendants, and specifically, Dr. Khan knew or should have known of Z.H.’s violent propensities, and likelihood that he would injure a third-party. Therefore, Mrs. Sinoracki claimed that Dr. Khan was negligent in not committing Z.H. to the hospital. Ultimately, the trial court granted the Defendants’ Motions for Summary Judgment, finding that the Defendants did not have a duty to the Sinorackis. Mrs. Sinorcki appealed the decision to the Superior Court.

The Pennsylvania Supreme Court has stated that Emerich v. Philadelphia Ctr. for Human Dev., 720 A.2d 1032 (Pa. 1998), is the “seminal case setting forth a mental health professional’s duty to warn third parties.” Maas v. UPMC Presbyterian Shadyside, 234 A.3d 427, 436 (Pa. 2020). The Emerich Court held “the circumstances in which a duty to warn a third party arises are extremely limited.” Maas, 234 A.3d at 437-438. Before a health care professional’s duty is triggered, the patient must communicate a “specific and immediate threat” against “a specifically identified or readily identifiable victim.” Id.

The Supreme Court in Maas extended the duty to warn to apply to circumstances where a specific threat is made against a readily identifiable group — in that case, “neighbors” residing in the patient’s apartment building. The Court reasoned that in those circumstances, the potential targets are not a large amorphous group of the public in general, but a smaller, finite, and relatively homogenous group united by a common circumstance. Id. at 439.

In this case, because Z.H. did not identify his neighbors or any member of the Sinoracki family as a potential target, the Defendants did not have a duty to specifically protect them. Without a finding of duty, the issue of breach of duty could not be submitted to a jury. Accordingly, the Superior Court affirmed the decision of the trial court.

Sinoracki v. The Children’s Service Center of Wyoming Valley, 2023 PA Super 170 (September 19, 2023) can be accessed here.