Application of the duty to protect to HIV-positive patients.

The spread of acquired immune deficiency syndrome (AIDS) has led to new questions regarding the limits of confidentiality in the psychotherapeutic relationship. We describe the duty-to-protect doctrine that has arisen out of Tarasoff and subsequent court decisions and apply it to situations in which human immunodeficiency virus (HIV)-positive patients may pose a health threat to others. No courts have as yet applied the duty to protect to cases of HIV infection. We conclude that although parallels exist between Tarasoff and HIV-infected patients, following good clinical practices can significantly reduce instances in which a duty to warn might arise. We recommend statutory solutions that would permit but not require warning potential victims of the HIV infection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applying Tarasoff to AIDS-related psychotherapy issues.

This article provides a framework, based on the Tarasoff decision and its sequelae, for examining several confidentiality issues that may emerge in psychotherapy situations related to acquired immune deficiency syndrome (AIDS). Four Tarasoff issues (special therapeutic relationship, dangerousness, identifiable victim, therapist's action to detain and/or warn) are described and applied to therapy situations with clients who have AIDS or are positive for antibodies. Recommendations are provided for psychotherapists dealing with such confidentiality dilemmas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of threats of violence under California's duty-to-protect statute

OBJECTIVE: This is the first study to assess clinical practices under one of the new duty-to-protect statutes, some version of which has been passed in many states. In 1985, California enacted a statute enabling psychotherapists to limit their liability when a patient makes a serious threat of violence by 1) making reasonable efforts to warn the victim of the threat and 2) notifying local police. METHOD: The authors examined all duty-to-protect notifications over a 5-year period in San Francisco by reviewing police and court records. RESULTS: Police received only 337 notifications, typically made by nondoctoral staff members at public facilities such as psychiatric hospitals and crisis clinics. Patients most commonly directed their threats toward family members. Of the patients who made threats resulting in notifications, 51% had prior arrest records, and 14% had subsequent arrests. Only 52% of the patients who made threats were civilly committed. CONCLUSIONS: The findings suggest that 1) clinicians rarely discharge the duty to protect in the manner specified by the law, 2) many patients whose threats result in notifications have extensive involvement with the criminal justice system, and 3) family intervention may have clinical relevance in many duty-to-protect situations.     

Tarasoff: 10 years later.

This article reviews the Tarasoff case and other cases decided since the California Supreme Court issued its decision. The changing interpretation of the decision, the broadening of its applicability, and legislative reactions are also discussed. Recommendations for psychotherapists who may have to make decisions about potentially violent clients are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Duty to protect: Update and Canadian perspective.

The Tarasoff decision in 1974 established a legal precedent for suits against psychologists who were aware that an outpatient in their care had threatened violence against a third party, but who failed to protect that person from danger. This report summarizes the current, somewhat confusing situation with regard to duty to protect, and suggests some steps that might be taken in Canada to make the boundaries of this duty more clear. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Segmental origin of sympathetic preganglionic neurones regulating the tail circulation in the rat

Few court rulings can have had the international impact on mental health professionals than the case of Tarasoff in the U.S.A. For psychiatric nurses the issues pertaining to this case affects the everyday working practices for those working with patients who, at one stage or another, threaten the welfare of others. This is as much the case for forensic psychiatric nurses as it is for general psychiatric nurses, and indeed any nurse who receives a threat, regarding a third party, from a patient. This paper sets out the brief history of the Tarasoff case and highlights the main issues for practitioners. Tarasoff and the problem of social control is discussed and the professional concerns regarding the prediction of violence and the duty to third parties are debated. The ramifications of the Tarasoff case, in terms of its restrictions and extensions, are outlined, and the impact for carers is discussed.     

Tarasoff: Five years later.

Examines the 1976 California Supreme Court decision of Tarasoff vs. Regents of the University of California et al, which required psychotherapists to take actions, including breach of confidentiality, to protect the public from violent patients. A 5-yr review of subsequent court decisions shows that courts differed with respect to the issue of liability when patients harmed persons who were not specifically threatened. Recommendations for psychotherapists are outlined to promote good clinical judgments in this area. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Psychotherapy with HIV-infected clients: Factors influencing notification of third parties": Comment.

Comments on the article by N. F. Kozlowski et al (see record 1998-10341-011) about HIV infected clients and whether or not there ought to be notification. Kozlowski et al cite the California case of Tarasoff v. Regents of University of California (1976) 9 times, however, they never officially cite it, nor do they put it in their reference section. Without going into a refresher course about the meaning of Tarasoff, when employing this case law in a study it is important to (1) carefully read the case, (2) become familiar with the case law in your state or states, (3) shepardize all relevant cases to make sure that they are still good law (there has been a lot of movement with Tarasoff over the years), and (4) have at least a consultation with an attorney who is familiar with this area of law. Legal accuracy is extremely important and without it, our studies cannot withstand interdisciplinary scrutiny. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal regulation of adolescent abortion: Unintended effects.

Legislatures often have established special procedures for judicial or parental involvement in adolescents' abortion decisions. Such procedures are intended ostensibly to protect pregnant minors' psychological health and increase the competence of their decision making. However, judicial bypass and parental notification statutes promote neither goal. At best, such statutes are benign but costly and purposeless. At worst, they increase pregnant minors' delay in seeking medical attention and induce embarrassment, anxiety, and family conflict. Additional research is needed to provide a foundation for legal decision making about the constitutionality of the actual operation of statutes regulating adolescent abortion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient psychotherapy with dangerous clients: A model for clinical decision making.

The precedent-setting 1976 judicial decision of Tarasoff v. Regents of the University of California established a duty to protect whereby psychotherapists are expected to exercise reasonable care to protect the potential victims of their clients' violent behavior. However, no standard of care for dangerous clients has been established. In this article, the authors present a model for clinical decision making to determine the best interventions for dealing with dangerous outpatient clients. The model takes into account the degree of violence risk and the strength of the therapeutic alliance. Four cases are presented to illustrate the application of the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Tarasoff raid: a new extension of the duty to protect

The authors discuss the general outlines of the Tarasoff duty of psychotherapists to protect potential victims of their violent patients. They describe the flexible range of clinical responses that therapists have utilized, as well as their professional concerns about preserving patient confidentiality (or at least strictly circumscribing the scope of disclosure when confidentiality must be breached). A recent case is reported that illustrates a striking new extension of Tarasoff, involving a police search and seizure of a psychotherapist's confidential treatment records and tapes, in response to a third-party complaint that the records contained evidence of his patients' violent acts and propensities. The implications of this case are that the therapist's discretion in the assessment of his duty to protect, the selection of a proper course of action, and the implementation of specific responses may be taken out of his hands, for all intents and purposes, and expropriated by law and order officials. Moreover, regardless of whatever clinical approach he adopts and whether or not he issues a warning, his attempts to preserve patient confidentiality are bound to prove unsuccessful in any future legal proceedings. Patient communications are likely to lose their confidential status on the grounds that they caused or triggered the Tarasoff warning (or that they should have triggered it). If the patient directed serious threats against the therapist himself, the court may find that, as a consequence, a "genuine therapeutic relationship" ceased to exist and thereafter all patient disclosures were no longer confidential on that basis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Tarasoff and the researcher: Does the duty to protect apply in the research setting?

In the decade since the Tarasoff decision, psychotherapists have become increasingly concerned about their responsibility to protect potential victims of their patients' violent behavior. Similarly, researchers in the mental health professions have expressed growing concern over their possible parallel obligations with regard to their research subjects. No case law to date imposes such a duty on researchers, but our analysis suggests that the congruence between the training and function of clinical researchers and psychotherapists will provide the touchstone for application of the duty to protect. In this article we discuss the issues that researchers should consider in assessing their potential duties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to Faustman.

Faustman (1982, see record 1982-28927-001) is incorrect when he states that "practitioners who choose to sue clients to recover fees are openly inviting countersuit by the client", (p. 213). I urge colleagues in other states to examine their confidentiality statutes for similar exemptions, and I admonish Faustman for not sufficiently investigating the legal issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is it proper for psychologists to discuss medications with clients?

Situations are analyzed in which psychologists might be asked for information about the efficacy or side effects of pharmacotherapy. The ethics and legality of providing information about physician-prescribed treatments by members of the health care delivery system who are not physicians are considered. Those articles in the psychologist's ethical code bearing on the issue are also discussed. Relevant court cases and statutes in the professions of nursing and pharmacy are examined. For these professions, the findings in relevant cases, coupled with the manner in which recent legislation has been written, suggest that nonphysician members of the health care delivery system can discuss treatments, including medications, prescribed by physicians. The question of a duty of psychologists to discuss medications in the context of obtaining informed consent is raised. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal issues in the assessment and treatment of individuals with dual diagnoses.

The difficult legal, ethical, and professional issues confronting psychologists who work with people with dual diagnoses are discussed here. Applicable constitutional principles are outlined in the context of discussing the right to institutional services and to refuse treatment, statutes that go beyond constitutional protections are described, issues that people with dual diagnoses face in the criminal and civil justice systems are highlighted, and some recommendations that psychologists should consider when providing services to this population are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV, confidentiality, and duty to protect: A decision-making model.

Mental health professionals are confronted with complex issues surrounding confidentiality and duty to protect when treating clients with HIV. These professionals need to consider various factors when applying Tarasoff principles to protect potential victims, including the foreseeability of harm, the identifiability of the victim, and appropriate protective action. Professional ethical guidelines and legal mandates also need to be considered. The purpose of this article is to discuss the ethical and legal dilemmas faced by clinicians and to introduce a decision-making model that takes into account individual state laws. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

How to analyze nurse practitioner licensure laws

Nurse practitioners (NPs) are capable of analyzing the regulation of their practice by state authorities. The annotated nursing statute, the medicine and pharmacy statutes, regulations from those three boards and cases noted in the annotated statutes should be read. Nurse practitioner definitions of practice can be broadly written (making relicensure in a state with similar definition easier) or specific (requiring all states to adopt similar qualifications for endorsement, as is done now with basic RN licensure). Requirements for NP credentialing by nonstate entities have advantages and problems too. State-granted monopoly of licensure is good for NP economics and bad for patient economics. Medical practice law is important to the NP. Pharmacy statutes are important even if the NP statute provides for prescribing. Revision of NP pharmacy law is becoming less necessary as more control of prescribing by guidelines is exercised on nurses and physicians alike. Rules for analysis of statutes are given.     

Child hearsay statutes: At once over-inclusive and under-inclusive.

Special child hearsay statutes allow for the admissibility of demonstrably reliable but otherwise inadmissible children's hearsay. These statutes were among other child witness innovations that proliferated in the 1980s and 1990s to redress the proof problems that arise in child sexual abuse prosecutions. The author argues that the special child hearsay statutes are at once over-inclusive and under-inclusive: over-inclusive in that child sexual abuse prosecutions typically include the testimony of the child witness and multiple hearsay witnesses; and under-inclusive in that they allow for the admissibility of children's hearsay in child abuse cases but may require the child declarant to be the child victim, excluding the hearsay statements of other child witnesses, and typically do not apply to the hearsay statements of children who witness crimes other than child abuse, like domestic violence. She proposes reforms to remedy these deficiencies in the special child hearsay statutes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Choosing to sever or maintain association induces biased impression formation.

Impression formation should be biased in individuals who decide to maintain or sever association because they desire to form impressions that support their decision. Because such individuals also should wish to appear objective, decision-supporting information should be irrelevant to obvious reasons for the decision ( e.g., a target's social stigma ) . Accepting the veracity of the target's stereotype-irrelevant attributes supports the decision and also can seem objective, although such processing is biased. In 2 experiments, participants were induced to choose or were assigned to maintain or sever association with an alleged fellow participant. Participants who chose to maintain or sever association used biased processes. In the 2nd experiment, the effect of choice on participants' communicated impressions was mediated by biased processes. The relation of this work to dissonance theory and implications for prejudice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Limiting therapist exposure to Tarasoff liability: Guidelines for risk containment.

The "duty to protect" 3rd parties, first imposed by the Tarasoff case, has concerned and perplexed clinicians. A series of guidelines is offered for reducing therapist exposure to suit, based on expert witness experience in a number of cases raising this form of tort liability. These guidelines concern the assessment and management of risk, the documentation of information and activities, the formulation of written policies, and damage control when risk is realized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)