DOLLIVER, J.
On May 14, 1977, plaintiff Cynthia Petersen was injured in an automobile accident in Tacoma. Plaintiff was making a lawful turn at an intersection when her car was struck by a vehicle driven by Larry Knox. The
At the time of the accident, Knox was on probation for a second degree burglary conviction. In May 1975, he had been sentenced by Superior Court Judge Hardyn B. Soule to 15 years in prison, suspended, subject to certain conditions of probation. Among the conditions of Knox's probation were that he participate in mental health counseling and refrain from using controlled substances.
Five days before the accident occurred, Knox had been released from Western State Hospital, where he had been receiving psychiatric care. On April 16, 1977, Knox had taken a knife to himself and cut out his left testicle. His brother had found him lying in a blood soaked bed and had taken him to Madigan Army Hospital for emergency medical treatment. After hospital staff reported delusional and hallucinogenic tendencies, Knox was evaluated by a mental health professional pursuant to RCW 71.05.150. On April 20, 1977, pursuant to RCW 71.05.180, Knox was admitted to Western State Hospital to be involuntarily detained for not more than 72 hours.
While at Western State Hospital, Knox was treated by Dr. Alva Miller, Clinical Director of the institution. Although Dr. Miller learned that Knox was on probation as a result of a burglary conviction, he apparently was unaware of the terms of probation. Dr. Miller also learned Knox had an extensive history of drug abuse, including the frequent use of the drug "angel dust" during the previous year. In fact, Knox told Dr. Miller he had taken angel dust just prior to the incident in which he emasculated himself.
As a result of his observation, Dr. Miller diagnosed Knox as having a "schizophrenic reaction, paranoid type with depressive features." Dr. Miller testified that his opinion at the time was that the "schizophrenic symptomatology was due primarily to the use of angel dust." Consequently, Dr. Miller prescribed Navane, an antipsychotic medication, for Knox.
Dr. Miller continued treatment and evaluation of Knox, including administration of the drug Navane. On May 8, 1977, just prior to his discharge, Knox was allowed to go home for Mother's Day but was required to return in the evening. That evening Knox was apprehended by hospital security personnel while driving his car on the hospital grounds in a reckless fashion that involved spinning his car in circles.
Nevertheless, Dr. Miller discharged Knox from the hospital the following morning. At the time, it was Dr. Miller's opinion Knox was not schizophrenic but that he had suffered a schizophrenic-like reaction from the angel dust he had taken. In Dr. Miller's opinion Knox had recovered from the drug reaction, was in full contact with reality, and was back to his usual type of personality and behavior.
Five days later, the accident occurred in which Cynthia Petersen was injured. As previously mentioned, Knox was under the influence of drugs at the time of the accident. It was later learned that Knox had flushed the Navane he received from Western State Hospital down a toilet.
Plaintiff brought this action against the State alleging it negligently treated Knox by failing to protect her from his dangerous propensities. Plaintiff argued that the failure of Dr. Miller to seek either additional confinement or to disclose information about Knox's parole violation was the proximate cause of her injuries. The jury agreed and rendered
The State raises a number of issues on appeal. (1) The psychiatrist had no duty to protect plaintiff from the dangerous propensities of a patient. (2) Even if the psychiatrist did have such a duty, the State is immune from liability for breach of the duty. (3) Plaintiff failed to present sufficient evidence that the actions of the psychiatrist were the proximate cause of plaintiff's injuries. (4) The trial court erred in submitting to the jury the question whether the psychiatrist acted with gross negligence in failing to petition the court for further confinement of Knox. (5) The trial court abused its discretion by allowing plaintiff to present evidence of Knox's subsequent criminal conduct and medical diagnosis and improperly refused an instruction limiting the use of evidence of Knox's subsequent criminal conduct. (6) The trial court incorrectly instructed the jury as to the liability of officers of the State when they act in good faith without gross negligence. (7) The trial court abused its discretion by allowing Superior Court Judge Soule to answer hypothetical questions posed by plaintiff.
Plaintiff raises an issue on cross appeal regarding the filing of a bond and the refusal of the trial court after plaintiff obtained her judgment to exonerate the bond which had been posted.
I
The question as to whether the State has a duty to protect potential victims from the dangerous propensities of a state hospital patient is twofold. First, does a state hospital psychiatrist have a duty to seek additional confinement of a patient who remains potentially dangerous after initial hospitalization? Second, under the specific circumstances of this case, was Dr. Miller required, or even allowed, to disclose information about the violation by Knox of the conditions of his parole to the Superior Court or to Knox's probation officer?
A
It is well settled that an essential element in any negligence
Restatement (Second) of Torts § 315 (1965).
We have not yet considered whether a psychiatrist has a duty to protect against injuries caused by a patient. In Kaiser v. Suburban Transp. Sys., 65 Wn.2d 461, 398 P.2d 14, 401 P.2d 350 (1965), we allowed a cause of action against a doctor favoring a third person who was injured by the doctor's patient where the doctor failed to warn his patient, a bus driver, of the side effects of a drug prescribed
The seminal case regarding the duty of a psychiatrist to protect against the conduct of a patient is Tarasoff v. Regents of Univ. of Cal., 17 Cal.3d 425, 551 P.2d 334, 131 Cal.Rptr. 14 (1976). In Tarasoff the plaintiffs alleged the defendant therapists had a duty to warn their daughter of the danger posed to her by one of the therapists' patients. The Tarasoff plaintiffs were parents of Tatiana Tarasoff, a young woman killed by a psychiatric patient. Two months prior to the killing, the patient informed his therapist that he intended to kill a young woman. Although the patient did not specifically name Tatiana as his intended victim, plaintiffs alleged, and the trial court agreed, that the defendant therapists could have readily identified the endangered person as Tatiana.
Applying Restatement (Second) of Torts § 315 (1965) to the facts before it, the Tarasoff court held the patient-therapist relationship was sufficient to support the imposition of an affirmative duty on the defendant for the benefit of third persons. Tarasoff, 17 Cal.3d at 435. The Tarasoff court ruled that when a psychotherapist determines, or, pursuant to the standards of the profession, should determine, that a patient presents a serious danger of violence to another the therapist incurs an obligation to use reasonable care to protect the intended victim against such danger. Tarasoff, 17 Cal.3d at 435. According to the Tarasoff court, discharge of the duty may require the therapist to take whatever steps are necessary under the circumstances, including possibly warning the intended victim or notifying law enforcement officials. Tarasoff v. Regents of Univ. of Cal., supra.
Although the Tarasoff decision did not emphasize the
B
The privilege of communications between psychologist and patient is set forth in RCW 18.83.110, which provides:
The statute essentially provides the same protection to psychologist-patient communications as is provided by RCW 5.60.060 for communications between physician and patient. Compare Department of Social & Health Servs. v. Latta, 92 Wn.2d 812, 601 P.2d 520 (1979) (physician-patient privilege) with In re Henderson, 29 Wn.App. 748, 630 P.2d 944 (1981) (psychologist-patient privilege). Both statutes are procedural safeguards which derogate from common law and therefore are strictly construed. See Latta, 92 Wn.2d at 819; In re Henderson, 29 Wn. App. at 752. The application of either privilege requires a balancing of the benefits of the privilege against the public interest of a full revelation of all the facts. See In re Henderson, 29 Wn. App. at 753. Accord, Dike v. Dike, 75 Wn.2d 1, 11, 448 P.2d 490 (1968).
A different privilege applies to confidential communications when a person is subject to the procedures of Washington's involuntary commitment act, Laws of 1973, 1st Ex. Sess., ch. 142, § 29, p. 1028. The involuntary commitment act contains a "patient's bill of rights" which details those privileges guaranteed the detainee within the institutional setting. See generally Comment, Progress in Involuntary Commitment, 49 Wash. L. Rev. 617, 620-24 (1974); Survey of Washington Law, Civil Commitment, 9 Gonz. L. Rev. 260, 264 (1973). The act includes strict safeguards to ensure the confidentiality of records, files, and other information, subject to certain limited exceptions. Specifically, RCW
RCW 71.05.390, as amended, Laws of 1975, 1st Ex. Sess., ch. 199, § 10, p. 661 (superseded by Laws of 1979, 1st Ex. Sess., ch. 215, § 17, p. 1885).
The interplay between the psychologist-patient privilege of RCW 18.83.110 and the confidentiality provisions of the involuntary commitment act, RCW 71.05.390, is best demonstrated by comparing Tarasoff v. Regents of Univ. of Cal., 17 Cal.3d 425, 551 P.2d 334, 131 Cal.Rptr. 14 (1976) to this case. There the court examined provisions of California's Lanterman-Petris-Short Act, which governs the release of confidential information in connection with involuntary commitment proceedings. Compare Cal. Welf. & Inst. Code §§ 5328-5328.9 (West 1972) with RCW 71.05. The Tarasoff court found the confidentiality provisions of the Lanterman-Petris-Short Act inapplicable since involuntary commitment proceedings had not been instigated
In the present case, Dr. Miller was prohibited by statute from informing Knox's probation officer of the fact of his involuntary commitment at Western State Hospital. Dr. Miller could release information obtained during Knox's involuntary commitment only within the guidelines of RCW 71.05.390. RCW 71.05.390(6)(c) (now RCW 71.05.390(7)(c)) allows release of information other than the mere facts of admission and discharge given the appropriate showing that disclosure is necessary. The statute prohibits, however, disclosure to anyone other than law enforcement personnel, who must request the information. RCW 71.05.390(6)(a) (now RCW 71.05.390(7)(a)). RCW 71.05 does not define the term "law enforcement" officers. RCW 43.101, however, distinguishes between "law enforcement personnel" and "correctional personnel":
RCW 43.101.010(4), (5).
Furthermore, Dr. Miller was prohibited from informing Judge Soule directly of the involuntary commitment of Knox at Western State. The hospital's records pertaining to Knox may be disclosed to the courts "as necessary to the administration of [RCW 71.05]." RCW 71.05.390(5) (now RCW 71.05.390(6)). The use of records pertaining to involuntary commitment "shall not be admissible as evidence in any legal proceeding outside this chapter". RCW 71.05.390. Accord, State v. Batten, 17 Wn.App. 428, 434, 563 P.2d 1287 (1977).
We agree with defendant that Dr. Miller was prohibited from disclosing information about the violation by Knox of
II
Having found that the State had a duty to take reasonable precautions to protect against the dangerous propensities of a state hospital patient, we must now determine whether the State is immune from liability for breach of the duty. In 1961 the Legislature adopted RCW 4.92.090. See Laws of 1961, ch. 136, § 1, p. 1680. The statute provides:
Evangelical United Brethren Church, 67 Wn.2d at 255, quoted in Haslund, 86 Wn.2d at 618. The Evangelical
King, 84 Wn.2d at 246, quoted in Haslund v. Seattle, 86 Wn.2d at 618.
The Washington courts have not yet determined whether a psychiatrist employed by the State is engaged in discretionary activity when treating patients at a state mental hospital. In Tarasoff v. Regents of Univ. of Cal., 17 Cal.3d 425, 551 P.2d 334, 131 Cal.Rptr. 14 (1976), the California Supreme Court concluded that the scope of discretionary immunity "should be no greater than is required to give legislative and executive policymakers sufficient breathing space in which to perform their vital policymaking functions." 17 Cal.3d at 445. Therefore, the Tarasoff court ruled that therapists employed by the State of California "are not immune from liability for their failure to warn of Tatiana's peril." 17 Cal.3d at 445. Similarly, in Lipari v. Sears, Roebuck & Co., 497 F.Supp. 185 (D. Neb. 1980), the court rejected the government's contention that negligent implementation of the Veterans Administration's policy on detention of potentially dangerous patients fell within the discretionary function exception to the Federal Tort Claims Act. Lipari, 497 F. Supp. at 195. The Lipari court held that the implementation as opposed to the development of an agency's rules and regulations does not involve policy judgments within the discretionary function exception. Lipari v. Sears, Roebuck & Co., supra. The Lipari court reasoned that the therapist's decision to detain a patient, although requiring professional expert evaluation, did not involve a balancing of policy considerations and was thus not a discretionary
III
Next we must determine whether plaintiff presented sufficient evidence that the actions of Dr. Miller were the proximate cause of her injuries. In order to prove actionable negligence, a plaintiff must be able to establish "(1) the existence of a duty owed to the complaining party, (2) a breach thereof, and (3) a resulting injury." LaPlante v. State, 85 Wn.2d 154, 159, 531 P.2d 299 (1975); Rosendahl v. Lesourd Methodist Church, 68 Wn.2d 180, 182, 412 P.2d 109 (1966). For legal responsibility to attach to the negligent conduct, the claim of breach of duty must be a proximate cause of the resulting injury. LaPlante v. State, supra; Pratt v. Thomas, 80 Wn.2d 117, 119, 491 P.2d 1285 (1971). A finding of proximate cause is premised upon proof of cause in fact as well as a legal determination that liability should exist. Bernethy v. Walt Failor's, Inc., 97 Wn.2d 929, 935, 653 P.2d 280 (1982). See King v. Seattle, 84 Wn.2d 239, 248-49, 525 P.2d 228 (1974).
Mathers v. Stephens, 22 Wn.2d 364, 370, 156 P.2d 227 (1945), quoted in Bernethy, 97 Wn.2d at 935. Accord, Bordynoski v. Bergner, 97 Wn.2d 335, 341, 644 P.2d 1173 (1982).
Here, plaintiff presented sufficient evidence to allow submission of the question of proximate cause to the jury. As the briefs amply demonstrate, the facts of the case are disputed and the inferences to be drawn from them may vary. Furthermore, unlike in Walters v. Hampton, 14 Wn.App. 548, 543 P.2d 648 (1975), a case relied on by the State, there are not in this case "too many gaps in the chain of factual causation to warrant submission of that issue to the fact finder." Walters, 14 Wn. App. at 555. The trial court did not err by submitting the issue of proximate cause of plaintiff's injuries to the jury.
IV
The next question is whether plaintiff presented sufficient evidence that the failure of Western State Hospital to protect her from the dangerous propensities of its patient constitutes gross negligence. The State asserts that plaintiff failed to establish a standard of care applicable to Dr. Miller's conduct, the violation of which would give rise to plaintiff's claim. It also claims that the testimony of other psychiatrists must be presented to establish what standard of care the professional community would require. Plaintiff counters that expert testimony would be needed only when the issue is whether the therapist "should have known" of a patient's dangerous propensities, according to the standards of the profession. Plaintiff argues that expert testimony is
In Tarasoff v. Regents of Univ. of Cal., 17 Cal.3d 425, 551 P.2d 334, 131 Cal.Rptr. 14 (1976), the California court rejected the notion that the adequacy of the therapist's conduct must be measured against a professional malpractice standard rather than "the traditional negligence standard of the rendition of reasonable care under the circumstances." Tarasoff, 17 Cal.3d at 439. As some commentators suggest,
(Footnote omitted.) Fleming & Maximov, The Patient or His Victim: The Therapist's Dilemma, 62 Calif. L. Rev. 1025, 1066-67 (1974). See generally Ennis & Litwack, Psychiatry and the Presumption of Expertise: Flipping Coins in the Courtroom, 62 Calif. L. Rev. 693, 734-43 (1974).
Plaintiff presented sufficient evidence of gross negligence on the part of Dr. Miller.
V
At trial plaintiff introduced evidence of acts committed by Knox subsequent to the accident in which plaintiff was injured. On December 6, 1977, Knox killed Mr. and Mrs. Hibberd and raped their daughter. Plaintiff also offered testimony from three psychiatrists who treated Knox after the accident with plaintiff occurred. Dr. Hugo Van Dooren, chairman of the psychiatric program at Puget Sound Hospital, testified that on approximately May 18, 1977, he diagnosed Knox as suffering from schizophrenia, catatonic type. Dr. Robert Anderson, a psychiatrist at Fairfax Hospital, testified that in August 1977 he diagnosed Knox's condition as schizophrenic, undifferentiated type, chronic and severe. Dr. Thomas Petek of the Greater Lakes Mental Health Center, who treated Knox from October 1975 to
In the present case, Dr. Miller testified that, in his opinion, Knox had fully recovered from his schizophrenic mental condition at the time of his discharge from Western State Hospital. The testimony of Drs. Van Dooren, Anderson, and Petek was offered to rebut Dr. Miller's testimony. The evidence of Knox's subsequent criminal conduct and medical diagnosis was admissible for that purpose.
The State argues the Superior Court improperly refused its proposed instruction limiting the use of evidence of Knox's subsequent criminal conduct. The State proposed two instructions limiting the use of this evidence. The trial court refused both of the State's proposed limiting instructions. The State's proposed instruction 5 provided:
The State's proposed instruction 14 provided:
Jury instructions should be read as a whole to determine their sufficiency. State v. Foster, 91 Wn.2d 466, 480, 589 P.2d 789 (1979). See State v. Dana, 73 Wn.2d 533, 537, 439 P.2d 403 (1968); Roberts v. Goerig, 68 Wn.2d 442, 455, 413 P.2d 626 (1966). Taken together, jury instructions are sufficient if they are readily understood and not misleading to the ordinary mind and permit a party to satisfactorily argue his or her theory of the case to the jury. State v. Foster, supra; State v. Dana, supra; State v. Long, 19 Wn.App. 900, 902, 578 P.2d 871 (1978). The number and specific language of the instructions are matters left to the trial court's discretion. State v. Long, supra; Levea v. G.A. Gray Corp., 17 Wn.App. 214, 224-25, 562 P.2d 1276 (1977).
VI
The State contends the trial court incorrectly instructed the jury regarding the liability of agents of the State for negligence in connection with involuntary commitment under RCW 71.05. Instruction 27, regarding the liability of agents of the State, stated:
(Italics ours.) The State argues the inclusion of the term "good faith" in instruction 27 provided a false issue for the jury and an alternative ground of liability which was not pleaded and which was not supported by any evidence.
A trial court has considerable discretion as to how instructions will be worded. Kjellman v. Richards, 82 Wn.2d 766, 768, 514 P.2d 134 (1973); Levea v. G.A. Gray Corp., 17 Wn. App. at 224-25. The court does not abuse its discretion when the instructions, read as a whole, properly inform the trier of fact on the applicable law. State v. Dana, 73 Wn.2d 533, 537, 439 P.2d 403 (1968); Levea v. G.A. Gray Corp., supra. Instruction 27 is a recitation of RCW 71.05.120 (amended, effective September 1, 1979). The statute sets forth the applicable law regarding the liability of state officers for negligent implementation of Washington's involuntary commitment act, RCW 71.05. The trial court did not abuse its discretion by presenting RCW 71.05.120 to the jury in the form of an instruction.
VII
Finally, the State argues that the trial court improperly allowed former Superior Court Judge Hardyn B. Soule to respond to hypothetical questions posed by plaintiff's counsel. At trial, plaintiff called Judge Soule as a witness to help show that Knox would have been confined on the day of the accident if Western State Hospital had contacted his probation officer. Plaintiff's counsel posed a hypothetical question assuming a number of facts previously presented as evidence and asked whether, assuming those facts, Judge Soule would have ordered a probation revocation hearing. The State contends that the trial court incorrectly allowed Judge Soule to respond to the hypothetical question. The State argues that the hypothetical question was based on mere speculation since a number of facts assumed in the hypothetical would have been inadmissible in a parole revocation hearing.
The trial court did not abuse its discretion by allowing Judge Soule to respond to the hypothetical question. One of the assumptions made by Judge Soule was that Dr. Miller would testify at the hypothetical parole revocation hearing. Judge Soule specifically stated, however, that he would not require Dr. Miller to testify at the hearing if it could be shown that the doctor-patient privilege precluded his testimony. Furthermore, the question was not whether Judge Soule would have revoked Knox's parole; rather, the question was, given the circumstances of the hypothetical, whether a hearing would be held. The testimony of Dr. Miller would not be crucial to the determination by Judge Soule whether to hold a parole revocation hearing. Therefore, the admissibility of Dr. Miller's testimony at the hearing was not a material fact necessary to the validity of the hypothetical question.
VIII
RCW 4.92.010 requires any person having a claim against the State to post a cost bond. Specifically, the statute requires:
Pursuant to RCW 4.92.010, plaintiff filed a bond with the Clerk of the Pierce County Superior Court. After plaintiff obtained her judgment, however, the Superior Court refused to exonerate the bond. On cross appeal plaintiff asserts the trial court erred in requiring her to post a bond pursuant to RCW 4.92.010 and in refusing to exonerate the
U.S. Const. amend. 14, § 1 provides that no state may "deny to any person within its jurisdiction the equal protection of the laws." Similarly, Const. art. 1, § 12 provides:
The requirements of the special "privileges or immunities" prohibition of Const. art. 1, § 12 are in most cases at least as stringent as those of the federal equal protection clause. Hunter v. North Mason High Sch., 85 Wn.2d 810, 819 n. 9, 539 P.2d 845 (1975). Ordinarily, inconsistency with one necessarily implies inconsistency with the other. Hunter v. North Mason High Sch., supra; State v. Perrigoue, 81 Wn.2d 640, 503 P.2d 1063 (1972).
The principle of equal protection "`does not require that things different in fact be treated in law as though they were the same". Jenkins v. State, 85 Wn.2d 883, 888, 540 P.2d 1363 (1975) (quoting Tussman & tenBroek, The Equal Protection of the Laws, 37 Calif. L. Rev. 341, 344 (1949)). The equal protection principle does require, however, "in its concern for equality, that those who are similarly situated be similarly treated.'" Jenkins, 85 Wn.2d at 888 (quoting Tussman & tenBroek, 37 Calif. L. Rev. at 344). If a statute creates an inherently suspect classification such as one based on race, nationality, or alienage, the statute, when challenged, will be subjected to strict scrutiny. Graham v. Richardson, 403 U.S. 365, 29 L.Ed.2d 534, 91 S.Ct. 1848 (1971); Nielsen v. Washington State Bar Ass'n, 90 Wn.2d 818, 820, 585 P.2d 1191 (1978). A statute which does not affect fundamental rights or create a suspect classification, however, is generally subjected to minimal judicial scrutiny and will not be invalidated unless it rests on grounds wholly irrelevant to the achievement of a legitimate state objective. McGowan v. Maryland, 366 U.S. 420,
Under the "minimum scrutiny" approach, the reviewing court must determine (1) whether the legislation applies alike to all members within the designated class; (2) whether there are reasonable grounds to distinguish between those within and those without the class; and (3) whether the classification has a rational relationship to the purpose of the legislation. Yakima Cy. Deputy Sheriff's Ass'n v. Board of Comm'rs, 92 Wn.2d 831, 835-36, 601 P.2d 936 (1979), appeal dismissed, 446 U.S. 979 (1980). Under the minimum scrutiny analysis, a challenged statute is presumed constitutional and the party challenging it has a heavy burden of showing there is no reasonable basis for the classification or the classification is contrary to the purpose of the legislation. Yakima Cy. Deputy Sheriff's Ass'n, 92 Wn.2d at 836.
The question of the constitutionality of RCW 4.92.010 was specifically addressed in Sheffield v. State, 92 Wn.2d 807, 601 P.2d 163 (1979). In Sheffield, plaintiffs sought damages for negligent administration of the State's foster home program. Shortly after the action was filed, plaintiffs moved to waive the cost bond required by RCW 4.92.010. The Superior Court denied plaintiffs' motion. The Supreme Court granted discretionary review and reversed the trial court's requirement that plaintiffs file a cost bond.
In a plurality opinion the Sheffield court held that RCW 4.92.010 violated the equal protection clause. Sheffield, 92 Wn.2d at 808-09. The plurality quoted with approval from Hunter v. North Mason High Sch., 85 Wn.2d 810, 539 P.2d 845 (1975), where the court held:
(Footnotes and citations omitted.) Hunter, 85 Wn.2d at 818-19, quoted in Sheffield, 92 Wn.2d at 808. The plurality concluded that the analysis and reasoning in Hunter as it applied to RCW 4.96.020 applies with equal force to RCW 4.92.010.
We affirm the judgment of the Pierce County Superior Court on the verdict for plaintiff of $250,000. We reverse the trial court's decision, however, insofar as plaintiff was required to post a bond for costs pursuant to RCW 4.92.010. We remand the case to the Superior Court with instructions to exonerate the bond.
Affirmed in part, reversed and remanded in part.
WILLIAMS, C.J., ROSELLINI, UTTER, BRACHTENBACH, DORE, and PEARSON, JJ., and HAMILTON, J. Pro Tem., concur.
DIMMICK, J., concurs in the result.
Reconsideration denied December 13, 1983.
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