52 Med.Sci.Law (1990) Vol.30, No. 1 Printed in Great Britain Dangerous Patients. Third Party Safety and Psychiatrists' Duties — Walking the Tarasoff Tightrope R.D. MACKAY BA, MPhil, Barrister Principal Lecturer in Law, Leicester Polytechnic, PO Box 143, Leicester LE1 9BH INTRODUCTION This paper concerns the vexed question of whether the law casts a duty upon psychiatrists to take action to protect third parties whom their patients have threatened to harm. Ifsuchaduty does exist in English law then failure to comply with it could result in legal liability. This is certainly the position in the United States where there have been a number of relevant cases — including, of course, the now famous Tarasoff case, which has fuelled controversy amongst lawyers and psychiatrists ever since it was decided in 1976. The purpose of this paper is twofold: first, to give a brief outline of the Tarasoff case itself followed by a review of subsequent US develop- ments; second, to make some attempt to predict whether English law might be prepared to adopt the Tarasoff approach. THE TARASOFF CASE (Tarasoff v Regents of University of California, 551 P2d 334, 1976) Prosenjit Poddar, an Indian national, was in- fatuated by a young woman called Titania Tarasoff who had rejected him. Poddar took the rejection hard and in the summer of 1969 while Titania was in Brazil, Poddar entered outpatient psychotherapy at a University of California hospital. During therapy Poddar expressed fantasies about killing Titania and at this time the therapist learned of the patient's plan to buy a gun. Deeply concerned about Poddar's propen- sity for violence, an attempt was made to have him committed which proved unsuccessful. After this Poddar dropped out of treatment with no further intervention by his mental health professionals. Two months later Poddar killed Titania at her home by shooting her with a pellet gun and then stabbing her. Poddar was later charged with first degree murder but the jury accepted his plea of diminished responsibility and he was convicted of manslaughter (see People v Poddar, 103 Cal Rptr878,1973). Since then Poddar has returned to India and is reported to be happily married (Stone, 1984). Titania's parents sued the University, claim- ing that the therapist had been negligent in failing to confine Poddar and in not warning Titania of the danger which the patient posed. The case first reached the California Supreme Court in 1974 when it was decided that: 'When a doctor .. in the exercise of his profes - sional skill and knowledge, determines, or should determine, that a warning is essential to avert danger arising from the medical or psychological condition of his patient, he in- curs a legal obligation to give that warning.' (529 P 2d 553, 1974) At this stage the American Psychiatric As- sociation (APA) filed an amicus curiae brief which voiced grave concerns about the decision 1 Based on a lecture delivered to the Royal College of Psychiatrists, Forensic Psychiatry Specialist Section Residential Conference on 17 February 1989.