POLICY PROCEDURE REGARDING:
Special Situation Governing Release of Information DUTY TO WARN
Jo Ruffin, L.C.S.W.
Deputy Director of Health
Date: June 20, 1997
|Manual Number: 3.06-09
Reference: Tarasoff vs. Regents of University of California - Case Law
(Substantive Revision. Replaces memo 3.06-09 of 4/1/91.)
The Tarasoff decision deals with responsibility of the psychotherapist to warn victims of
potential violence by clients. Simply stated, this means that the psychotherapist-patient privilege
is overshadowed by the therapist's responsibility to warn an intended victim.
- The general legal requirements for DMS staff in regard to Tarasoff warnings follow:
- The psychotherapist's duty does not arise only where the psychotherapist has actual
knowledge of danger. It arises whenever the therapist determines, or pursuant to
standards of the profession should determine, that the patient presents a serious
danger to another. If a patient threatens physical violence against someone, the threat
must be a serious one and the victim or victims must be reasonable identifiable.
Some examples of when a victim is "reasonably identifiable" include: a) the victim is
specifically named by patient (ex. Bob Smith of 123 Sesame Street); b) the victim is
easily identifiable by their relationship to the patient (ex: my mother, brother,
employer, colleague, competitor, etc.); or c) other easily recognizable trait (ex.: the
Mayor, my congressman, the anchor for the Channel 22 5 p.m. news hour). In order
to discharge the duty to warn, the psychotherapist must make reasonable efforts to
communicate the threat to the victim or victims and must notify a law enforcement
- Persons to be notified in a Tarasoff situation must include the intended victim, and
the police. The therapist must take all necessary steps to warn the victim of the
circumstances such as attempting to contact the potential victim by telephone and/or
letter. This may include telling other persons who are in a position to warn the
victim. It is reasonable to provide the name and address of the client making the
threats and the nature of the violence that the client has threatened. It is not
permissible to provide the police or the victim access to confidential patient records
without a valid court order, however.
- Serious consideration should be given to initiating a 72-hour involuntary evaluation hold
pursuant to Welfare & Institutions Code 5150 on the patient.
- Once a decision has been made as to how the situation will be handled clinically, this should
be carefully charted . The therapist needs to chart what information was disclosed, to whom,
when and why.
- The name and location of the law enforcement agency contacted and the name and badge
number of the officer must also be included in the chart.
- A written incident report must always be completed by clinical staff and distributed through
appropriate Quality Improvement channels when a Tarasoff warning has taken place. This
report would include the name of the staff member issuing the warning, the name of the
supervisor and any other persons involved in the decision, as well as the circumstances
surrounding the warning. In addition, the report must indicate:
- The patient communicated to the psychotherapist a threat of physical violence.
- That this threat was a serious one.
- The reasons why the victim or victims were reasonably identifiable. The report must
be received at 1380 Howard Street within one week of the incident.
If a therapist makes a Tarasoff warning by making reasonable efforts to communicate the threat
to the victim/s and to a law enforcement agency, the therapist is immune from suit by the
victim/s even if the victim is subsequently injured. Civil Code §43.92(b). Moreover, such
disclosures are authorized by law, Welfare & Institutions code 5328 ( r) and do not breach
client/therapist confidentiality rules.
Contact Person: Susan Sturtevant, Health Information Management Director, 255-3484.
Administrative Manual Holders
DMS Direct Treatment Programs
DMSF policies and procedures are distributed by the Quality Management Section, Susan
Sturtevant, Dir., Health Information Management unit, 255-3484.
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