The State of Minnesota Court of Appeals (“Minnesota Court of Appeals”) held in its opinion filed on February 16, 2021, “Because Short’s mental-health provider owed a duty of care to him as a matter of law, and because genuine issues of material fact exist as to whether Short’s family members were foreseeable plaintiffs and whether familicide was a risk foreseeable to the mental-health provider, dismissal of the action at summary judgment was improper. We therefore reverse and remand for trial.”
The Underlying Facts
In the three months leading up to the deaths of Brian Short (“Short”) and his family members, Short sought treatment for symptoms of anxiety and depression on nine separate occasions from multiple Park Nicollet Health Services (“Park Nicolett”) practitioners. On June 16, 2015, Short visited a Park Nicollet urgent care facility, citing concerns about stress and anxiety and wanting to rule out heart-related conditions. Short had a scheduled appointment to see his primary care doctor two days later, but he expressed that he could not wait that long for an evaluation. Short reported no history of psychological problems, such as depression, and he denied any suicidal or homicidal ideations. A physician assistant (PA) treated Short in urgent care. The PA ruled out cardiac issues, prescribed Xanax for the anxiety, and directed Short to follow up with his primary care doctor.
On June 18, 2015, Short visited his primary care doctor, also a Park Nicollet practitioner, for a full physical examination. The primary care doctor documented that Short wanted to address issues including “anxiety and depressed mood,” that Short had lost 20-30 pounds, that Short denied suicidal ideation but stated that his “mood ha[d] been a little bit down here over the last 2 or 3 weeks,” and that Short was experiencing difficulty sleeping. The primary care doctor prescribed 100 mg Zoloft and directed Short to take one-half of a pill daily to start, to increase the dosage to a full pill after four or five weeks, if necessary, and to return for a recheck in five weeks, if needed.
On June 27, 2015, Short returned to the Park Nicollet urgent care facility and again saw the PA. The PA documented continuing issues with anxiety and insomnia and noted that the Zoloft prescribed by Short’s primary care doctor did not yet appear to be effective. The PA prescribed Ambien and Ativan and noted that Short should follow up with his primary care doctor as needed.
On July 6, 2015, Short returned to his primary care doctor with complaints of anxiety and insomnia. The primary care doctor documented that, “Overall symptoms are moderate to severe.” The doctor instructed Short to increase to the full dose (100 mg) of Zoloft, refilled the Ativan, and prescribed trazodone in place of Ambien to help with sleep. Short’s primary-care doctor also suggested that Short see a counselor.
On July 15, 2015, Short saw an advanced practice registered nurse in Park Nicollet’s psychiatry department. The nurse documented that Short had been referred by his primary care doctor and that Short had not noted significant improvement in his symptoms since starting the medications prescribed. The nurse administered an assessment known as a PHQ-9, on which Short scored 23 out of 27, indicating severe depression.
On the PHQ-9 form, Short reported that nearly every day during the preceding two weeks, he had felt down, depressed, or hopeless; struggled to fall asleep or stay asleep; had a poor appetite; felt bad about himself—that he was a failure or had let himself or his family down; and struggled to concentrate. Short reported that on more than half the days, he had had little interest or pleasure in doing things, and he reported that on a few days, he had had thoughts that he would be better off dead or of hurting himself in some way. On the question regarding self-harm, Short included a handwritten note after circling the number representing “Several Days.” The handwritten notes reads, “I wouldn’t say several days but a few.”
The nurse diagnosed Short with major depression, single episode, severe, without psychosis, as well as generalized anxiety disorder and panic disorder. She directed Short to continue with the same dose of Zoloft, increased his dose of Ativan, referred him to therapy, and directed him to return to see her in four weeks, or sooner if needed.
On July 16, 2015, Short saw a Park Nicollet licensed social worker for psychotherapy. The social worker documented that Short “denie[d] suicidal ideation, intent, or plan.” Short saw the social worker again on August 4, 2015, but no PHQ-9 was conducted on that date. Short had a final appointment with the social worker on August 12, 2015 at which time no PHQ-9 was completed, but the social worker documented that Short “continue[d] to struggle with symptoms of depression and anxiety.”
On August 14, 2015, Short had a final visit with the nurse. The nurse documented that, with the exception of insomnia, all but one of Short’s symptoms were unchanged or worse. On that date, the nurse prescribed Lexapro to replace Zoloft and instructed Short to return in four to six weeks, or sooner if needed.
Short had an appointment scheduled with the social worker for August 27, 2015, but Short rescheduled that appointment to September 10, 2015. On September 10, 2015, Short was found dead in his home, having fatally shot his wife, his three teenaged children, and himself.
A trustee filed a Minnesota mental health wrongful death lawsuit alleging that Park Nicollet Health Services and others breached standards of care by failing to properly assess, evaluate, and treat Short’s severe depression; failing to properly inform Short and his family members of the risks and benefits of the prescribed medications, forms of therapy, and possible alternative treatments; failing to properly monitor Short’s response to medications prescribed by Park Nicollet healthcare providers; and, failing to obtain Short’s informed consent for elected treatments.
Following discovery, Park Nicollet moved for summary judgment. The district court granted the motion, concluding that Park Nicollet owed no duty to Short or his family members as a matter of law. The trustee appealed.
Minnesota Appellate Court Opinion
The Minnesota Appellate Court stated that, generally, whether a duty exists is a question of law for resolution by the court. But when duty depends on foreseeability, and the material facts regarding foreseeability are disputed, or there are differing reasonable inferences from undisputed facts (a ‘close call’), summary judgment on the element of duty should be denied and the negligence claim, including the issue of foreseeability, should be tried.
The Minnesota Appellate Court held: “Based on well-established duties healthcare providers owe to their patients, we hold that Park Nicollet owed a duty to Short “to act with the required standard of skill and care,” Becker, 737 N.W.2d at 216, and that the district court erred by granting summary judgment in favor of Park Nicollet on appellant’s claim arising out of Short’s suicide … we conclude that a mental-health provider’s lack of custody or control over a patient does not undermine or negate its legal duty to provide treatment in accordance with the applicable standards of care.”
The Minnesota Appellate Court further held: “The district court again concluded that because Park Nicollet did not have custody or control over Short, it owed no duty to protect his family members from the harm inflicted by Short. Because genuine issues of material fact exist as to whether members of the Short family were foreseeable plaintiffs and whether familicide was a risk foreseeable to Park Nicollet, the district court erred in entering summary judgment of dismissal on the claims arising out of the deaths of Short’s family members … Park Nicollet may have owed a duty of care to Short’s family members as Short’s healthcare provider if harm to Short’s family members was a foreseeable risk of the alleged departures from the standard of care. Park Nicollet may also owe a duty based on its own conduct that created a foreseeable risk of harm. We recognize the general rule that a person owes no duty to protect another from harm caused by a third party … But Minnesota law recognizes exceptions to this rule. As is relevant here, such a duty may arise when the defendant’s own conduct creates a foreseeable risk to a foreseeable plaintiff.”
The Minnesota Appellate Court explained: “The district court erred in concluding that the existence of foreseeability was foreclosed as a matter of law because the record contained no evidence of a previous violent incident or attempt at self-harm and merely included expert testimony that the departures from the standards of care created a foreseeable risk of harm to Short’s family members … we are aware of no Minnesota authority requiring proof of a previous violent incident to meet the legal threshold of foreseeability.”
The Minnesota Appellate Court held: “Our review of the totality of record evidence regarding foreseeability, including the expert opinions, viewed in the light most favorable to appellant, demonstrates that genuine issues of material fact exist regarding the foreseeability of familicide. To be clear, we do not hold that the familicide was in fact a foreseeable risk for members of the Short family. This case falls into the category described by the supreme court as a “close call” where the issue of foreseeability must be tried before a jury.”
The Minnesota Appellate Court stated, however: “Our conclusion that Park Nicollet owed a duty to Short is not dispositive of whether Park Nicollet is ultimately liable for damages stemming from Short’s suicide. At trial, appellant will be required to prove through expert testimony that Park Nicollet departed from the applicable standards of care and that those departures were the cause of Short’s suicide … Park Nicollet and its experts contest liability, and the resolution of these genuine disputes is for the jury. Our holding is limited to the unremarkable legal proposition that Park Nicollet, as a mental-health treatment provider, owed a duty to Short as its patient and that the existence of that legal duty is not contingent on Park Nicollet’s custody or control of Short. Accordingly, the district court erred in granting summary judgment to Park Nicollet on appellant’s claim arising out of Short’s suicide.”
Source Smits v. Park Nicollet Health Services, A20-0711.
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