Pangburn v. SaadPangburn v. Saad
Lead Opinion
W
Plаintiff brought this action for compensatory and punitive damages for personal injuries suffered as a result of the wrongful release of her brother, Daniel Olin Pangburn, from Cherry Hospital in Goldsboro,
Plaintiff asks this Court to recognize a cause of action for injuries resulting from the wrongful release of a mental patient. She also asserts that N.C. Gen. Stat. Sec. 122-24 (1981), which allegedly confers immunity on Dr. Saad, as a State hospital medical staff member, for his decision to release Daniel Pangburn, is unconstitutional and thus presents no barrier to recognition of a causе of action. Defendant argues that plaintiffs action is barred because this is a medical malpractice action and there is no privity between plaintiff and Dr. Saad. Further, defendant contends that even if this Court recognizes a cause of action for wrongful release of a mental patient, G.S. Sec. 122-24 (1981) provides defendant with absolute immunity from personal liability.
We hold that plaintiff has stated a claim for relief against Dr. Saad, based on his wrongful release of her brother, and we further hold that G.S. Sec. 122-24 (1981) affords only a qualified immunity, immunizing physicians only from liability for their ordinary negligent acts but not from liability for their “wilful, wanton or recklessly” negligent acts or their intentional acts. As plaintiff has sufficiently alleged a cause of action against Dr. Saad for his decision to release Daniel Pangburn, the order of the trial court must be reversed.
II
The initial barrier posed by defendant Saad to recognition of plaintiffs cause of action is that there is no physician-patient privity bеtween plaintiff and Dr. Saad. Defendant contends that such privity is an absolute prerequisite to a medical malpractice action. However, we are not faced with a medical malpractice action. The Supreme Court of Georgia rejected this exact argument on a wrongful death claim brought against the State: “[T]his is not a malpractice case; it is an ordinary negligence case in which privity has never been an essential element.” Bradley Center, Inc. v. Wessner,
‘[WJhere the course of treatment of a mental patient involves an exercise of “сontrol” over [the patient] by a physician who knows or should know that the patient is likely to cause bodily harm to others, an independent duty arises from that relationship and falls upon the physician to exercise that control with such reasonable care as to prevent harm to others at the hands of the patient.’
Id. at 201,
Addressing a factually comparable claim, the Fourth Circuit has said: “Apparently, no Virginia case deals with a claim similar to [plaintiffs], so we must resort to thе general principles of the Virginia law of torts.” Semler v. Psychiatric Institute,
Ill
As we find that a cause of action exists, we must next examine the impact of G.S. Sec. 122-24 (1981), which provides:
No administrator, chief of medical services, or any staff member under the supervision and direction of the administrator or chief of medical services of any State hospital shall be personally liable for any act or thing done under or in pursuance of any of the provisions of this Chapter.
Dr. Saad stated in his affidavit that he was a staff psychiatrist under the supervision and direction of the Administrator or Chief of Medical Services of Cherry Hospital. The release оf Daniel Pangburn, an involuntarily committed patient, was apparently accomplished under G.S. Sec. 122-58.13 (1981). Clearly, then, the provisions of G.S. Sec. 122-24 (1981) seem to immunize defendant from liability, and the only reported cases found construing G.S. Sec. 122-24 (19 ) and its predecessor support this conclusion.
In Bollinger v. Rader,
IV
A.
We next address plaintiffs constitutional challenge. Plaintiff attacks the constitutionality of G.S. Seс. 122-24 (1981) on two separate grounds: (a) that it violates the equal protection clause of Art. I, Sec. 19 of the North Carolina Constitution, and (b) that it violates the “open courts” provision found in Art. I, Sec. 18 of the North Carolina Constitution.
The statute does not violate our equal protection clause. The classification drawn in G.S. Sec. 122-24 (1981) distinguishes staff members of a State mental hospital from staff members of non-included hospitals, or possibly from all other State employees. As no suspеct class or fundamental right is involved, the lower tier of equal protection analysis, the “rational basis” test, is employed. This test requires that distinctions drawn by a challenged statute bear some rational relationship to a conceivable legitimate government interest. Abbott v. Town of Highlands,
B.
Article I, Sec. 18 of our Constitution provides, inter alia, that “every person for an injury done him in his lands, goods, person, or reputation shall have remedy by due course of law. . . .” Plaintiff argues that if she is barred from bringing suit against Dr. Saad, she is denied a remedy fоr her
[T]he remedy constitutionally guaranteed must be one that is legally cognizable. The legislature has the power to define the circumstances under which a remedy is legally cognizable and those under which it is not.
Lamb, then, ostensibly supports the constitutionality of G.S. Sec. 122-24 under Art. I, Sec. 18. However, there is language in Lamb which questions its constitutionality:
We refrain from holding, as our Court of Appeals did [in the Lamb decision] and as other courts have done, that the legislature may constitutionally abolish altogether a common law cause of action. Neither do we mean to say that it cannot. The question is not before us.
308 N-C. at 444,
Lamb is not the first occasion on which the Supreme Court has declined to consider the constitutional question. In Bolick v. American Barmag Corp.,
The plaintiff in this case alleges that she was injured by the negligent or intentional act of a state employee, a cause of action cognizable at common law. Wirth v. Bracey,
If G.S. Sec. 122-24 (1981) confers absolute immunity on those it protects, it becomes obvious that an injured person can sue neither the State nor the individual physician when a physician acts maliciously, corruptly, or in bad faith in releаsing a mental patient. We thus reach the question of whether the legislature intended to include intentional torts within the scope of the immunity provided by the statute. Since we find no discussion of the policy behind G.S. Sec. 122-24 codified in the statute, or embodied in case law, we look to analogous North Carolina authority and authority
We . . . conclude that an intentional tort is not the type of ‘industrial accident’ to which our legislature intended to give a co-employee immunity. To hold otherwise is to remove responsibility from the co-employee for his intentional conduct. [Citation omitted.] Why should he be concerned about the consequences of his acts if the cost of any intentionally-inflicted injury will be absorbed by the industry?
Andrews v. Peters,
The holding in Andrews has recently been expanded. Despite authority to the contrary and the lack of an express statutory provision, our Supreme Court held thаt “the Workers’ Compensation Act does not shield a co-employee from common law liability for willful, wanton and reckless negligence.” Pleasant v. Johnson,
By its seeming grant of absolute immunity, G.S. Sec. 122-24 (1981) is unlike other North Carolina statutes of its genre. Thesе other statutes generally grant a qualified, rather than an absolute, immunity, and thus do not extend the immunity to situations in which the otherwise protected person has acted in bad faith, unreasonably, or maliciously. See, e.g., N.C. Gen. Stat. Sec. 166A-14 (1982) (Emergency Management Act; no liability for employee’s actions “except in cases of willful misconduct, gross negligence or bad faith”); N.C. Gen. Stat. Sec. 90-48.8 (1981) (members of dental peer review committee not liable for actions if not malicious and reasonable belief action warranted); N.C. Gen. Stat. Sec. 7A-550 (1981) (persons reporting child abuse); N.C. Gen. Stat. Sec. 90-171.47 (Supp. 1983) (persons reporting misconduct of nurses). Even N.C. Gen. Stat. Sec. 122-58.8A (Supp. 1983) (effective 1 January 1984), a newly-enacted statute providing immunity to both public and private mental health facilities, and their staffs, for actions connected with outpatient commitment, only grants immunity when the facility, physicians and staff “follow accepted professional judgment, practice and standards in thе management, supervision and treatment of the respondent.”
Turning next to the law of other jurisdictions, we find that:
It is generally recognized that public officers and employees would be unduly hampered, deterred and intimidated in the discharge of their duties, if those who acted improperly, or even exceeded the authority given them, were not protected to some reasonable degree by being relieved from private liability. Accordingly, the rationale for official immunity is the promotion of fearless, vigorous, and effective administration of policies of government. The threat of suit could also deter competent people from taking office.
63A Am. Jur. 2d Public Officers and Employees Sec. 358 at 924-5 (1984), and cases therein cited. Although the modern trend has been to grant more and more immunity to public officials, id., there has been a marked restriction on the circumstances in which absolute immunity is available.
These general policy considerations are particularly well-suited to actions against a state psychiatrist (or a state hosрital) for the release of a patient. Significantly, the various policy reasons for immunity apply exclusively to ordinary negligence actions; they have no relevance to grossly negligent and intentional acts. In determining whether state mental hospitals may be held liable for the negligent release of patients, an Ohio Court discussed policy considerations which are also pertinent to the liability of the individual physician:
Both private and public hospitals are fаced with the extremely difficult task of balancing the interests of a patient who would benefit from permanent or periodic release, the interest of society in treating mental illness and returning the patient to a normal, productive life, and the interests of society in keeping a dangerous, mentally ill person off the streets. The uncertainties inherent in analyzing and treating the human mind, let alone the decision of when a person is ‘cured’ and no longer a danger, renders the decisions of skilled doctors highly discretionary and subject to rebuke only for the most flagrant, capricious, and arbitrary abuse.
Leverett v. State,
In Bellavance v. State,
There is a vital public interest in securing the earliest possible release and subsequеnt return to society of a person afflicted with mental illness, and it may well be argued that to subject the State to liability for the negligent release of these people will have a chilling effect upon . . . [that goal]. However, this potential chilling effect is significantly mitigated by . . . Section 768.28(9):
‘No officer, employee, or agent of the state or its subdivisions shall be held personally liable in tort for a final judgment which has been rendered against him for any injuries or damages suffered as a result of any act, event, or omission of action in the scope of his employment or function, unless such officer, employee, or agent acted in had faith or with malicious purpose or in a manner exhibiting wanton and willful disregard of human rights, safety, or property.'
Clearly, it is only under a most exacting standard that State employees may be subjected to ultimate personal liability.
We also doubt that the potential liability of the State itself will be a significant inhibitor to the exercisе of professional judgment by the personnel involved. Indeed, some inhibiting effect may well be healthy, for it should not be forgotten that the State’s employees serve the needs of society as a whole as well as the needs of individual persons. Further, we cannot envisage any remedy, other than a tort suit for damages, to which the [plaintiffs] can resort.
Id. at 424-5. See also St. George v. State,
In both the Bellavance and Leverett cases, supra, the applicable statutes granted only a qualified immunity to the individual physicians. This appears consonant with the trend, noted above, limiting the extension of absolutе immunity. See 42 Pa. Cons. Stat. Ann. Sec. 8522 (Purdon 1982) (abolishing sovereign immunity as a bar to an action arising out of a negligent act, including acts of “health care employees of Commonwealth agency medical facilities or institutions . . .”). The Ohio statute relied on in Leverett, and the court’s commentary thereon, is instructive:
Persons acting reasonably and in good faith, either upon actual knowledge or information thought by them to be reliable, who procedurally or physically assisted in the hospitalization or discharge of a person pursuant to this chapter, do not come within any criminal provisions, and are free from any liability to the person hospitalized or to any other person.
Ohio Rev. Code Ann. Sec. 5122.34 (Page 1977). The Leverett Court explained:
[T]he General Assembly intended for doctors practicing in mental hospitals to be free from liability for the discharge of patients if such discharge is reasonable and in good faith. Conversely, such an expressed intention necessarily implies that doctors could be liable at some time, presumably when they act unreasonably or in bad faith.
Thеrefore, the case law from other jurisdictions is replete with justifications for extending a qualified immunity to state psychiatrists for the negligent release of a patient. Our research has failed to disclose a single cogent reason for shielding the grossly negligent or intentional wrongdoer from the consequences of his or her acts. We reiterate that G.S. Sec. 122-24 (1981) is an anomaly among North Carolina statutes granting immunity, and further note that a judicial limitation has been placed on thе facially absolute statutory immunity granted under the Workers’ Compensation Act, G.S. Sec. 97-10.1 (1979), to achieve the perceived legislative intent under analogous circumstances. See Andrews v. Peters. We therefore conclude that G.S. Sec. 122-24 was intended to create a qualified immunity for those state employees it protects, extending only to their ordinary negligent acts. It does not, however, protect a tortfeasor from personal liability for gross negligence and intentional torts. G.S. Sec. 122-24 does not, then, abolish a cause of action and leave the injured plaintiff without her remedy, but only defines the circumstances in which relief will be available. The statute, as construed, is thus constitutional and does not violate the “open courts” provision of Art. I, Section 18.
V
In conclusion, if plaintiff has stated a claim against Dr. Saad for his grossly negligent or intentional acts, it will withstand dismissal, since it will fall outside the statutory protection of G.S. Sec. 122-24 (1981).
The pertinent allegations of the Complaint are as follows: Daniel Pangburn has been under psychiatric care since childhood and has a history of emotional disorders and violent behavior which has included attacks on family members, including the plaintiff. Daniel has been committed to Cherry Hospital on at least seven occasions since 1979, and defendant is aware of Daniel’s psychiatric, mental and emotional history. On 25 February 1982, a petition was filed in Onslow County Superior Court for the involuntary commitment of Daniel Pangburn. He was examined by defendant, who found him to be suicidal, dangerous to himself and others, and to have threatened physical harm to his family and others. Based on the recommendation of Dr. Saad, on 3 March, 1982, Daniel Pangburn was involuntarily committed to Cherry Hospital for 90 days. On the morning
A Complaint will not be dismissed unless it appears that plaintiff is not entitled to relief under any state of facts that could be presented in support of the claim. Andreson v. Eastern Realty Co.,
Reversed and remanded.
Concurrence Opinion
concurring.
I believe that this case should be decided under rules of law applying to public officers generally, it being my position that the immunity statute at issue in this case codifies those rules as applicable to physicians employed at state hospitals.
Public officers acting within the scope of their authority are not answerable for ordinary negligence, but may be held liable if they act maliciously or corruptly.
A defendant acts with malice when he wantonly does that which a man of reasonable intelligence would know to be contrary to his duty and which he intends to be prejudicial or injurious to another. . . . ‘An act is wanton when it is done of wicked purpose, or when done needlessly, manifesting a reckless indifference to the rights of others.’ . . .
In re Grad v. Kaasa,
In her complaint, plaintiff alleges facts and circumstances showing that plaintiffs family, including herself, were in great fear of harm from plaintiff’s brother, whо was in defendant’s care; and that these fears were clearly and forcefully expressed to defendant, while the family was imploring defendant not to release Daniel Pangburn from Cherry Hospital.
Plaintiff alleges that defendant, though aware of Daniel’s violent and dangerous propensities and aware of his family’s fear of him, “persisted in releasing Daniel Olin Pangburn and thus exhibited gross negligence and wanton conduct.” These allegations were sufficient to state a claim for relief against defendant, sufficient, at the pleadings level to overcome defendant’s immunity.