The Supreme Court of Tennessee researched what other courts have been saying. It found that other states are reaching the same conclusion in these cases, that mental health practitioners have a legal responsibility to take necessary steps to protect caregivers working with their patients with a known potential for violence.

   The court upheld a jurys verdict against a patients attending psychiatrist of more than $1 million in favor of a nurse who sustained severe head injuries inflicted by a violent psychiatric patient while the nurse was working with the patient on the psychiatric unit.

   According to the court, a psychiatrists first responsibility to caregivers is to evaluate whether his or her patient poses a danger to nurses and other staff who will be working with the patient.

   In this case the psychiatrist already knew the patient well. The patient had been on the unit five times before during manic phases of his long-term bipolar illness. Three of those times the patient had been adjudged to pose a danger to himself and to others and had been held and treated involuntarily.

   When the patient came in voluntarily this time he told the emergency room resident he had not been taking his lithium. The resident assessed the patient as disorganized, grandiose and delusional. The resident admitted him to try to bring his lithium back up to therapeutic levels.

   Less than an hour later the psychiatrist wrote a note his patient was aggressive, grandiose, intimidating, combative and dangerous. The court itself highlighted this from the chart. The psychiatrist’s plan, such as it was, was to wait for the patient to leave against medical advice. Later that evening the patient brutally attacked a staff nurse.