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Missouri Court of Appeals Holds a Healthcare Provider Has No Legal Duty to Protect a Patient's Child from Unforeseen Criminal Abuse by a Third Party

ABSTRACT: The Missouri Court of Appeals, Eastern District, affirmed a defense verdict in a suit in which the plaintiff alleged a hospital negligently caused an infant to suffer shaken baby syndrome by failing to alert authorities about potential child abuse by the patient/mother’s then-boyfriend. The court held that a converse jury instruction instructing that the jury should find for the hospital if it believed the boyfriend injured the infant, along with evidence of the boyfriend’s fault, was not improper because the hospital owed no legal duty to protect the infant from the unforeseen act of a third party outside the patient-provider relationship.

In June 2023, the Missouri Court of Appeals, Eastern District, affirmed a defense verdict for Poplar Bluff Regional Medical Center in Hollis v. Poplar Bluff Regional Medical Center, LLC, a suit brought by an infant (through the mother as next friend) alleging the hospital negligently failed to alert authorities about the patient/mother’s potential for committing child abuse and thereby caused the child to suffer shaken baby syndrome. The mother had been a voluntary patient in the hospital’s psychiatric ward over five days, about four months before the child abuse occurred. After the child was injured, the mother pleaded guilty to child abuse. The plaintiff alleged the hospital negligently failed to report the mother’s risk for committing child abuse or neglect when the mother was a patient. However, at trial, the trial court permitted the hospital to introduce evidence that the mother’s boyfriend at the time, rather than the mother herself, was the one who abused the child and caused his injuries. The trial court also allowed the hospital’s converse jury instruction that the verdict must be for the hospital if the jury believed the boyfriend injured the infant. The jury found the hospital not liable for the infant’s injuries. On appeal, the plaintiff made several arguments, but we will focus on the claims of trial court error surrounding the hospital’s converse jury instruction admission of the hospital’s evidence that the boyfriend caused the infant’s injuries.

Missouri recognizes a general common law rule that there is no legal duty to protect someone from a third party's criminal act. The reason that courts do not generally impose such a duty is because criminal acts are rarely foreseeable. The touchstone for the creation of a legal duty is foreseeability – if a healthcare provider were held liable for failing to warn of any potential harm that a third party might cause to another third party, there would be almost no limit to the potential legal liability. In Missouri, as in other states, there is, however, an exception to this general rule. Nearly 30 years ago, in Bradley v. Ray, 904 S.W.2d 303, 311 (Mo. App. W.D. 1995), the Court of Appeals held that liability for a failure to warn may be imposed only where there is a "special relationship" between a healthcare provider and a patient who is the foreseeable perpetrator of harm against a readily identifiable victim.

In reaching its holding, the Bradley court discussed Tarasoff v. Regents of Univ. of Cal., 17 Cal. 3d 425 (Cal. 1976). the seminal case imposing a legal duty on a healthcare provider to warn an impending victim of foreseeable violence at the hand of a patient. In that case, a patient informed a university psychologist that he intended to kill Tatiana Tarasoff before he took her life. Tarasoff's parents filed suit, alleging the university psychologist owed Tarasoff a duty to warn of the threat. The California Supreme Court noted that foreseeability was the most important consideration in establishing whether a duty exists. The court acknowledged the difficulty of predicting whether a mental health patient may criminally act against his intended victim but held the "special relationship" between a psychologist and a patient establishes a duty of care for the safety of both the patient and "any third person whom the [mental health provider] knows to be threatened by the patient.”  Most jurisdictions, including Missouri, have adopted a Tarasoff duty exception.

Just as Bradley relied on the analysis in Tarasoff, the Hollis court looked to the holding in Bradley, the sole Missouri case addressing a failure to warn in the context of child abuse where the victim was abused by a patient who had a "special relationship" with a mental healthcare provider. Bradley emphasized the critical role of foreseeability in establishing duty even under the recognized narrow "special relationship" exception. Critically, Bradley noted that the duty to warn arose not only from the special relationship between the healthcare provider and the patient, but from the healthcare provider having specific knowledge that the patient posed a dangerous threat to a third party, as well as having sufficient time and ability to prevent the harm.

Since Bradley, there has been at least a narrow duty to warn relevant to Missouri mental healthcare providers in certain situations. Notably, however, Missouri courts have refused to expand the "special relationship" exception to create a blanket duty for a mental healthcare provider to warn the public at large about dangerous propensities of a patient.

Following this standard, the Hollis court reasoned that evidence of a special relationship between the hospital and the mother arising out of her mental health treatment could impose on the hospital a duty to warn of foreseeable child abuse by the mother, but not for abuse at the hands of a third party who was not a hospital patient. The hospital’s converse instruction in Hollis was proper because if the boyfriend and not the mother abused the infant, then it negated any legal duty to warn because the boyfriend was not a hospital patient. Bradley, as well as Tarasoff and its progeny, imposed a duty to warn because the harm to the victim by the patient (rather than by a third party) was foreseeable by the mental healthcare providers.

Ultimately, the Hollis court explained that if the child abuse that injured the plaintiff was committed by the patient’s boyfriend, as submitted in the court’s instructions to the jury, then the foreseeability of such abuse would be too speculative to establish a duty to warn arising out of a patient-provider relationship with the mother. “To hold otherwise potentially would make a mental health provider liable for an indeterminate range of harms for an indeterminate amount of time.”


The holding in Hollis clarifies that in Bradley, which imposed a duty to warn of a foreseeable risk of future abuse by a patient against a child only when the patient is in a special relationship with a mental health provider and the patient is the perpetrator of the child abuse. Because of the critical role of foreseeability in establishing a duty, the duty to warn does not apply to third parties outside of the special relationship between a patient and healthcare provider, as imposing liability in such a manner would be impossible to foresee. In other words, healthcare providers should keep in mind that they may have a duty to warn of risks of a patient committing harm to a third party, but there is generally no such duty to warn of potential risk of harm committed by a third-party individual who is not a patient.

* Hans Liu, 2023 Summer Law Clerk, assisted in the research and drafting of this post. Liu is a rising 3L student at Washington University School of Law.