Client Advisory

Rachel S. Rubenstein, Matt Choi

In a recent decision, the Supreme Court of Connecticut held for the first time that where a mental health provider actually knows that its patient poses a substantial risk of imminent physical harm to an identifiable victim, the provider owes a common-law duty to exercise reasonable care to the victim to protect him or her from the danger, extending the duty of health care providers to third parties and bringing the law of Connecticut in line with other jurisdictions, including Delaware, New Jersey, and New York.

In 2022, Caroline Ashworth ended a three-year romantic relationship with Michael Mollow, moving out of their residence and taking their truck, which Mollow could track via GPS. Mollow presented the next morning at an emergency department, where he expressed specific homicidal ideation toward Ashworth and reported that he was “obsessed” with her, depressed, insomniac, using alcohol and street-obtained Xanax, and owned firearms. Based on this information, a physician executed a fifteen-day, involuntary emergency certificate under Connecticut law, opining that Mollow had psychiatric disabilities, was a danger to himself or others, and needed immediate care and treatment in a hospital and certifying that he presented with positive homicidal ideation toward his former girlfriend. The next day, the hospital transferred Mollow to the psychiatric hospital at defendant St. Vincent’s Medical Center, where he reiterated his homicidal ideation and requested medication to stop his intrusive thoughts. Two days later, St. Vincent’s discharged Mollow to follow up with his primary care physician and a social worker, with no plans for further supervision. The following morning Mollow tracked Ashworth via GPS and shot and killed her before taking his own life.

Ashworth’s estate sued St. Vincent’s, alleging that it failed to exercise reasonable care in its assessment, treatment, monitoring, and discharge of Mollow and to warn Ashworth of the danger he posed to her though it knew or should have known of such danger. The trial court granted St. Vincent’s motion to strike the counts against it finding that, because the estate’s claims sounded in medical malpractice, they were barred in light of Connecticut precedent providing that a medical malpractice claim can be asserted only by a patient.

On appeal, the Connecticut Supreme Court reversed the trial court, holding that to the extent that the allegations involved St. Vincent’s non-medical judgment, they sounded in ordinary negligence. The Court noted that other allegations involving the exercise of professional medical judgment sounded in medical practice.
To the extent that the claims involved ordinary negligence, the Court recognized for the first time, that, in the limited circumstances that a mental health care provider has actual knowledge that its patient poses a substantial risk of imminent physical harm to a specifically identifiable third party, it owes a duty of reasonable care to protect that person. In doing so, the Court observed the State’s important objective of preventing violence against others, as strongly suggested by the State’s statutory provision for involuntary commitment.

The Court dismissed St. Vincent’s arguments that the imposition of this kind of duty would “open the floodgates” to a broad wave of nonpatient liability, observing that such risks were mitigated by the limited nature of the duty. The Court also observed that this ruling was consistent with the prevailing approach adopted in numerous other jurisdictions, including California, Delaware, Illinois, New Jersey, and New York.

In light of this ruling, mental health providers must consider this ruling when risks to third parties are disclosed during patient treatment. Providers should consider consulting with legal counsel with relevant experience to develop policies and training related to instances where patients present specific threats to identifiable third parties. Mental health providers should also consider how threats are documented and assessed and may consider legal consultation where potentially qualifying patient threats arise.

You can read the full Supreme Court of Connecticut opinion here.