An Analysis of the Physician Impact of Smits v. Park Nicollet MN Supreme Court Decision

January 12, 2023

In September 2022, the Minnesota Supreme Court issued an opinion in the case of Smits v. Park Nicollet Health Services that could have negative impacts on mental health providers and the treatment they provide in Minnesota. 

What happened in the case? 

A patient was being seen for mental health services on an outpatient basis by Park Nicollet when he murdered his family before committing suicide. The patient’s next of kin sued Park Nicollet and Health Partners claiming that the patient’s violent acts were foreseeable and more should have been done to prevent the patient’s actions, even though the patient had no history of prior violence, made no threats of violence, and was not in the custody of Park Nicollet. 

How was the MMA involved? 

The MMA and the Minnesota Hospital Association participating as amicus curiae, submitted a brief explaining how this significant expansion of liability would negatively impact the mental health system in Minnesota. 

What did the Minnesota Supreme Court decide? 

1) Park Nicollet and its physicians do have a duty to protect a patient from self-harm, even if they are not in their custody, and  

2) Park Nicollet physicians do not have a duty to protect a patient’s family from the violent acts of a patient absent a custodial relationship, history of violence, or threats of violence.  

In Minnesota, a physician owes a duty to avoid causing foreseeable harm to their patients and may owe a duty of care if there is a foreseeable risk of harm to others. In the case of a patient’s self-harm or suicide, a physician owes a duty of care when that patient is in the custody of the physician (being treated as an inpatient). In this case, the patient was not in the physical custody of Park Nicollet but was being treated as an outpatient. However, the Court found that Park Nicollet physicians still owed a duty to the patient because they agreed to treat him.  

As for a duty owed to the patient’s family, a physician owes a duty to individuals for the acts of their patients if those acts are foreseeable. Foreseeability can be established by a history of violence or by explicit threats being made. In this case, none of the aforementioned factors exist and, the Court agreed. The Court held that the harm committed by the patient against his family was outside the scope of what could have been foreseeable to Park Nicollet physicians and that “’severe’ depression on its own cannot make patient violence legally foreseeable.” 

Why is this case important for Minnesota physicians? 

The portion of the opinion that found Park Nicollet physicians could be responsible for the self-harm of their patient puts Minnesota physicians in a difficult position when treating mental health conditions. The opinion encourages physicians to use more drastic treatments or to admit patients as opposed to treating them as outpatients because the physicians could still be held responsible for the patient’s behavior. 

On the other hand, the portion of the opinion that found Park Nicollet physicians did not have a duty to protect the patient’s family from the unforeseeable violent actions of their patient will maintain the status quo and help to continue destigmatizing mental health diagnoses. The Court itself acknowledged the harm that could occur if foreseeability of violence could be established by a diagnosis of depression alone when it stated, “holding that any patient with untreated depression and anxiety is a foreseeable murderer is not supportable and would certainly serve to stigmatize a population in need of further assistance.”   

Resource: 

SMITS AS TRUSTEE FOR SHORT v. PARK NICOLLET HEALTH SERVICES | FindLaw