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Marshall v. Klebanov

July 26, 2006

CRAIG S. MARSHALL, ADMINISTRATOR AD PROSEQUENDUM OF THE ESTATE OF ELLEN S. MARSHALL, DECEASED, PLAINTIFF-RESPONDENT,
v.
VLADIMIR KLEBANOV, M.D., DEFENDANT-APPELLANT.



On appeal from the Superior Court, Appellate Division, whose opinion is reported at 378 N.J. Super. 371 (2005).

SYLLABUS BY THE COURT

(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized).

The issue before the Court is whether the statutory immunity provisions of N.J.S.A. 2A:62A-16 (Section 16 of the statute) apply to immunize a psychiatrist from liability when it is alleged that the psychiatrist abandoned a seriously depressed patient and negligently failed to provide the patient with adequate monitoring or treatment.

In February 2000, thirty-six-year old Ellen Marshall, the decedent, hanged herself two days before her scheduled appointment with Dr. Vladimir Klebanov, a licensed psychiatrist. In 1997, decedent and her family moved from Franklin Park to Marlboro and, thereafter, she began to suffer from depression and suicidal thoughts. She was admitted to Riverview Medical Center for about one week and placed on "suicide watch," after taking an overdose of prescription medication. Following her release, decedent was treated with Prozac and Wellbutrin for about a year and claimed to have felt better.

In December 1999, decedent suffered another episode of depression and in late December, accompanied by her sister and mother, went to see Dr. Klebanov, who was about to open an office in Old Bridge near her home. Decedent made an appointment for January 7, 2000 to begin treatment with Dr. Klebanov at this new office. At that appointment, decedent described her symptoms, including a family history of anxiety attacks, fears or phobias, depression, and suicide attempts. She claimed to have trouble sleeping, felt fatigued, had crying spells, felt sad or depressed every day, avoided social events, had suicidal thoughts and weight loss. Dr. Klebanov diagnosed decedent with "major depression, recurrent, severe." He found that she suffered from depressed mood, blunted affect, poor judgment, and poor insight. He noted that she had suicidal thoughts but that she had no plan to commit suicide. Dr. Klebanov prescribed Lithium to augment the effects of decedent's other medication, increased her dosage of Prozac, maintained her dosage of Wellbutrin, and decided to see her again in one week for follow-up care.

On January 14, 200, decedent returned to Dr. Klebanov's office for her appointment but was not seen by the doctor for reasons that are disputed by the parties. Decedent's husband, Craig Marshall, claims it was over the fact that his wife did not have the money to pay for the visit and the doctor's office did not accept credit cards. Dr. Klebanov claims that a patient would never be refused treatment for failure to pay and that decedent was encouraged to stay for her appointment, especially in light of the need to monitor her medications, but that she decided to leave and wait for her medical insurance to be straightened out. Decedent made another appointment for February 4, 2000, which she did not make, having committed suicide two days before.

Craig Marshall filed a medical malpractice and wrongful death action on behalf of himself and his wife's estate against Dr. Klebanov, alleging that the doctor deviated from accepted standards of care in the evaluation, treatment, and care of decedent. Marshall's expert opined that Dr. Klebanov deviated from the appropriate standard of care in his treatment of decedent in that he essentially abandoned her by failing to provide adequate monitoring and treatment and failed to refer her elsewhere.

Dr. Klebanov moved for summary judgment, asserting that he was immune from liability under Section 16, which sets forth a mental health practitioner's "duty to warn and protect" patients or third parties against a patient's violent acts. The trial court granted Dr. Klebanov's motion based on the plain language of the statute. A divided panel of the Appellate Division reversed on appeal. The majority concluded that Section 16 does not bar Marshall's claims, reasoning that the purpose of the statute was not to immunize mental health practitioners from all liability for a patient's suicide, regardless of the reasonable likelihood of suicide or the gravity of the practitioner's deviation from the requisite standard of care. The dissent argued that the majority's conclusion contradicted the statute's plain language.

This appeal comes before the Court as of right based on the dissent in the Appellate Division.

HELD: The statutory immunity provisions of N.J.S.A. 2A:62A-16 do not immunize a mental health practitioner from potential liability when the practitioner abandons a seriously depressed patient and fails to treat the patient in accordance with accepted standards of care in the field.

1. Under New Jersey's common law, a physician must act with that degree of care, knowledge, and skill ordinarily possessed and exercised in similar situations by the average member of the profession practicing in the field. If a physician deviates from the applicable standard of care in the treatment of the patient and that deviation proximately causes harm to the patient, then the physician is liable for damages caused by his professional negligence. A psychiatrist can be found to have breached his professional duty of care if he knew or should have known that a patient presented a risk of suicide requiring special precautions. (Pp. 9-12)

2. Under Section 16, enacted in 1991, a mental health practitioner is immune from civil liability for a patient's violent act against another person or himself unless the practitioner incurred a duty to warn and protect the potential victim as set forth in the statute and fails to discharge that duty. A mental health practitioner incurs a duty to warn and protect when the patient has communicated to that practitioner a threat of imminent, serious, physical violence against another or himself and a reasonable professional in the practitioner's area of expertise would believe the patient intended to carry out the threat or would believe the patient intended to carry out an act of imminent, serious physical violence against another or against himself. A practitioner discharges that duty by: arranging for admission or involuntary commitment of the patient into a hospital or appropriate care facility; advising law enforcement of the threat and identity of the victim; or warning the intended victim (or victim's caregiver) of the threat. (Pp. 13-14)

3. In interpreting a legislative enactment, the overriding goal is to determine the Legislature's intent. A statue in derogation of the common law should be strictly construed. Doubt about the meaning of such statutes should be resolved in favor of the effect that makes the least rather than the most change in the common law. This canon of statutory interpretation works in conjunction with the principle that statutes granting immunity from tort liability should be given narrow range. (Pp. 14-17)

4. The statute's legislative history makes clear that Section 16 only was intended to codify a specific case and to clarify the ways in which a mental health practitioner can discharge the duty to warn and protect potential victims of violence without incurring liability for disclosure of confidential information. Notably absent from the legislative history is any mention of the intent to immunize mental health practitioners from liability for deviations from accepted standards of care in the treatment of such patients. (Pp. 17-18)

5. A practitioner's common-law duty to exercise that degree of skill, care, and knowledge for his patient that would be followed by any reasonable member of the profession under like circumstances exists separate and apart from any duty to warn and protect. Here, the separate duty of care would involve the alleged abandonment of a patient by failing to provide the patient with adequate monitoring or treatment. Even if a practitioner does not incur a duty to warn and protect under the statute, he may be liable for a breach of his duty to treat a patient in accordance with applicable medical standards. Section 16 does not bar Marshall's claims against Dr. Klebanov under the common law for abandoning decedent and failing to treat her in accordance with applicable standards of care. Moreover, Dr. Klebanov did not incur a duty to warn and protect because decedent's suicide was not imminent under the statute. (Pp. 18-22)

Judgment of the Appellate Division is AFFIRMED as MODIFIED and the matter is REMANDED to the trial court for further proceedings consistent with this opinion.

JUSTICE RIVERA-SOTO, DISSENTING, is of the view that the Legislature made it clear that no duty to warn and protect equals immunity from any civil liability. Insofar as the majority agrees that Dr. Klebanov was under no duty to warn and protect decedent, the majority similarly should honor the Legislature's clearly stated view that the inquiry is at an end and no liability can be imposed on Dr. Klebanov.

CHIEF JUSTICE PORITZ and JUSTICES LONG, LaVECCHIA, and WALLACE join in JUSTICE ZAZZALI'S opinion. JUSTICE RIVERA-SOTO filed a separate dissenting opinion. JUSTICE ALBIN did not participate.

The opinion of the court was delivered by: Justice Zazzali

Argued April 3, 2006

In this appeal, the Court must decide whether the statutory immunity provisions of N.J.S.A. 2A:62A-16 apply to immunize a psychiatrist from liability when it is alleged that the psychiatrist abandoned a seriously depressed patient and negligently failed to provide the patient with adequate monitoring or treatment. In February 2000, thirty-six year old Ellen Marshall, the decedent, hanged herself two days before a scheduled appointment with defendant, Dr. Vladimir Klebanov, a licensed psychiatrist. Following her death, the decedent's husband, plaintiff Craig Marshall, filed an action against defendant on behalf of himself and his wife's estate for medical malpractice and wrongful death, alleging that defendant deviated from accepted standards of care in the evaluation, care, and treatment of his wife. Defendant moved for summary judgment, asserting that he was immune from liability under N.J.S.A. 2A:62A-16, which sets forth a mental health practitioner's "duty to warn and protect" patients or third parties against a patient's violent acts.

The trial court granted defendant's motion for summary judgment based on the plain language of N.J.S.A. 2A:62A-16a. On appeal, a divided panel of the Appellate Division reversed. The majority concluded that N.J.S.A. 2A:62A-16 does not bar plaintiff's claims, stating that "[t]he purpose of the statute was not to immunize mental health practitioners from all liability for a patient's suicide, regardless of the reasonable likelihood of suicide or the gravity of the practitioner's deviation from the pertinent standard of care." Marshall v. Klebanov, 378 N.J. Super. 371, 379 (App. Div. 2005). The dissent argued that the majority's conclusion contradicted the statute's plain language. Id. at 381 (Fuentes, J., dissenting). We affirm and hold that the statutory immunity provisions of N.J.S.A. 2A:62A-16 do not immunize a mental health practitioner from potential liability when the practitioner abandons a seriously depressed patient and fails to treat the patient in accordance with accepted standards of care in the field.

I.

Because this matter is before the Court on defendant's motion for summary judgment, we review the facts in the light most favorable to plaintiff, the non-moving party. R. 4:46-2(c); Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520, 540 (1995). The decedent, Ellen Marshall, was born in 1963 and married plaintiff, Craig Marshall, at age twenty-three. She gave birth to two sons, one in 1992, and one in 1995. In 1997, the family moved from their home in Franklin Park to Marlboro. Around that time, the decedent developed depressive and suicidal thoughts due to financial concerns. Although she had been diagnosed with psychiatric problems during high school, her psychiatric history indicates that she felt relatively well for many years until she moved in 1997. That year, the decedent was admitted to Riverview Medical Center for approximately ...


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