Section 11 Immunities and Defenses

• Library: Mental Health 2006

There are various immunities and defenses afforded for implementing measures to protect patients from harming themselves or others.

Missouri has statutorily provided qualified immunity related to civil detention actions. Section 632.440, RSMo 2000, provides the following immunity:

No officer of a public or private agency, mental health facility or mental health program; no head, attending staff or consultant of any such agency, facility or mental health program; no mental health coordinator, registered professional nurse, licensed physician, mental health professional nor any other public official performing functions necessary for the administration of this chapter [Comprehensive Psychiatric Services]; no peace officer responsible for detaining a person pursuant to this chapter; and no peace officer responsible for detaining or transporting, or both, any person upon the request of any mental health coordinator . . . or acting pursuant to the request of a guardian . . . or upon the request of the head of any supervisory mental health program . . . , regardless of whether such peace officer is outside the jurisdiction for which he serves as a peace officer during the course of such detention or transportation, or both, shall be civilly liable for detaining, transporting, conditionally releasing or discharging a person pursuant to this chapter or chapter 475, RSMo [Probate Code—Guardianship], at or before the end of the period for which the person was admitted or detained for evaluation or treatment so long as such duties were performed in good faith and without gross negligence.

To prove that a person acted with “bad faith” requires evidence that the person acted with “a dishonest purpose, moral obliquity, conscious wrongdoing, breach of a known duty through some ulterior motive or ill will partaking of the nature of fraud.” State ex rel. Twiehaus v. Adolf, 706 S.W.2d 443, 447 (Mo. banc 1986). “Gross negligence” is “reckless conduct done with knowledge that there is a strong probability of harm and indifference as to that likely harm” or a “willful and wanton abrogation of professional responsibility . . . conduct so egregious as to warrant an inference of a mental state unacceptable in a professional.” Boyer v. Tilzer, 831 S.W.2d 695, 698 (Mo. App. E.D. 1992).

Several cases have upheld the statutory immunity afforded in Missouri for individuals involved in issues related to civil detention. In Boyer, persons injured by a mental patient brought an action against a psychiatric resident who released the patient from a mental health facility. The plaintiffs argued that the psychiatric resident was grossly negligent in releasing the patient, which would defeat the immunity. The evidence was that the psychiatric resident misdiagnosed the patient’s condition as PCP psychosis when it was actually paranoid schizophrenia. In the court’s opinion, a “misdiagnosis may be negligent, but it does not constitute conscious indifference tantamount to willful and wanton abrogation of professional duties.” Id. at 698. The court thus concluded that there was no evidence that the psychiatric resident did not perform his duties in good faith and without gross negligence as required for the immunity under § 632.440 to apply.

A similar result was reached in Bunting v. Huckstep, 853 S.W.2d 448 (Mo. App. E.D. 1993). A patient in a state mental hospital wandered from her assigned ward, was struck by a motor vehicle, and subsequently died. The plaintiff alleged that the mental health professionals:

• knew of the patient’s propensity to wander

• knew of the unsafe, insecure, and understaffed conditions; and

• were, therefore, negligent in exercising their judgment regarding the degree of restraint and supervision required by the patient

The plaintiff attempted to couch his allegations in terms of medical malpractice or failure to supervise. But in the opinion of the court, the...