(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.

1. The general legal requirements for DMS staff in regard to Tarasoff warnings follow:
   1. 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 agency.
   2. 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.
2. Serious consideration should be given to initiating a 72-hour involuntary evaluation hold pursuant to Welfare & Institutions Code 5150 on the patient.
3. 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.
4. 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.
5. 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:
   1. The patient communicated to the psychotherapist a threat of physical violence.
   2. That this threat was a serious one.
   3. 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.

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DMSF policies and procedures are distributed by the Quality Management Section, Susan Sturtevant, Dir., Health Information Management unit, 255-3484.