Doctors owed no duty to nonpatient, Illinois high court rules

A recent Illinois Supreme Court ruling is a victory for patient-physician confidentiality and protects doctors from unwarranted liability exposure, physicians said.

On Sept. 24, the high court ruled that a group of physicians and other health care professionals did not have a duty to prevent the murder of the wife of a mentally ill patient they treated.

Richard Street sought psychiatric treatment at Community Resource Center Inc. in 2003 after he reported thoughts that his wife was trying to poison him, court records said. Street told the doctors and hospital social workers caring for him that he planned to kill his wife, Teresa Street, and that he wanted to be admitted to a psychiatric facility. He changed his mind during the admitting process and returned home, while continuing his medication treatment.

Three days later, Richard Street was found lying over the body of his strangled wife. He ultimately pleaded guilty to murder and was sentenced to 18 years in prison, records show.

Teresa Street's family sued the hospital, several physicians and other health care workers for wrongful death, alleging that they had failed to treat her husband properly and failed to warn his wife of his potentially violent tendencies.

But the Supreme Court unanimously concluded that the doctors and others owed no duty to Teresa Street, since she was not their patient.

Justices recognized that doctors may have a responsibility to third parties in limited circumstances involving a "special, intimate relationship," typically between a mother and a fetus. But a marital relationship, as in this case, did not qualify to allow third parties to transfer doctors' duty of care outside a direct patient-physician relationship, the court said.

Physicians expressed concern that if the case had gone the other way, the decision could have jeopardized the privacy of mental health patients' sensitive information and ultimately their care.

Illinois State Medical Society President James L. Milam, MD, said the Legislature passed laws governing the release of mental health information, which generally is allowed only with the patient's permission. The ISMS filed a friend-of-the-court brief supporting the doctors in the suit.

"But this case would have essentially created an exception where one didn't exist," Dr. Milam said. "If patients don't know that what they share with their doctors is going to be held in the strictest confidence, especially in terms of mental health, it may have serious negative effects on that relationship" and deter patients from seeking treatment.

Extent of duty depends on relationship

The case also threatened to expand physicians' liability to third parties with whom doctors have no relationship, Dr. Milam said.

State law gives doctors leeway to share patient information voluntarily with family members or law enforcement if physicians believe, in their medical judgment, that such disclosures are appropriate, he said. But they are not mandatory, and doctors make those decisions for the benefit of their patients, not third parties.

"We take care of patients one at a time," Dr. Milam said.

But trial lawyers who weighed in on the case said doctors should be held accountable when they know that someone could be harmed by their patients.

The suit involved "a specific, identifiable potential victim, and court rulings and statutes in a number of states have recognized a duty in those types of situations," said Kirsten M. Dunne, a personal injury lawyer with Goldberg Weisman Cairo in Chicago. She authored a friend-of-the-court brief in the case on behalf of the Illinois Trial Lawyers Assn.

For example, Teresa Street also participated in her husband's care in attending some of his doctor appointments and providing doctors with information about his condition, Dunne said. Such involvement not only lessened some of the confidentiality concerns but also showed that as Richard Street's wife, she relied on the physicians and others to treat him properly, Dunne said.

Plaintiffs still would have to prove negligence, "but this ruling does cause some concern, because they don't even get to go forward to establish liability," she said. "The court just found there was no duty ... but the courts can limit it to specific types of circumstances if they feel it's appropriate."

This should have been one of those cases, Dunne said.