There are times when a physician (your doctor) might be conflicted with new information that you provide to them. Whether or not they need to report it. We all know the "Patient-Doctor confidentiality" however, at what point is a Doctor duty bound to "break" that code?

A thread!

Prosenjit Poddar was a grad student of University of California, Berkeley in September 1967. He met a young lady called Tatiana Tarasoff in the fall of 1968.
They began to date.

Prosenjit had different ideas about the relationship. He believed the relationship was serious however, Tatiana was just catching vibes. When she learnt of his views on the nature of their relationship she basically told him to "Come off it"
She was involved with other men.

Well, like anyone who just had their ass handed to them. This hurt Prosenjit and he built a feeling of resentment towards her.

Instead of taking his L like a man and move on. He began stalking Tatiana

Subsequently, Poddar went into an emotional crisis as everything rapidly devolved into a mental break down for him.
He became depressed and began to self-neglect. His studies took a tumble. Grades went down. Unprovoked weeping episodes. All of that.

This went on for a while till the summer of 1969. He had several meetings with Tatiana and often taped the meetings just to find out why she didn't share the same feelings as him, about their relationship.

(Me: Dude... seriously?)

Tatiana Tarasoff travelled to South America in the Summer of 1969 and in that period, Prosenjit Poddar got better. He went into therapy and had some psychologic improvement.
He was a patient of Dr Lawrence Moore, a psychologist at UC Berkeley.

In one of their sessions, he confided in Dr Moore of his intentions to kill Tatiana. Dr Moore flagged this and asked that Poddar be detained, detailing that he believes that Poddar suffers from Paranoid schizophrenia. He should be confined as a dangerous person.

He was indeed detained however he was soon released, as he appeared "rational".
*Me thinking* Really? Rational? Haven't they heard of Schneider's First Rank Symptoms?

Dr Moore's supervisor, Dr Harvey Powelson asked that Poddar not be subject to further detention.

(Me: wonderful)

After Tatiana returned from her trip, Poddar stopped visiting his psychiatrist. Stopped therapy. Befriended Tatiana's brother and they even lived together.

All seemed normal....or were they?

On October 27, 1969, Poddar carried out the plan he had confided in his psychologist, killing Tatiana Tarasoff. He stabbed her to death.

He was convicted of 2nd degree murder but the conviction was later appealed and overturned on the grounds that the jury didn't have full information.

*Me thinking*
American Legal system na wa oooo

A re-trial didn't happen and Poddar was released on the condition that he would return to his home country of India.

Prosenjit Poddar walked.

(Me: MIND=BLOWN)

Tatiana Tarasoff's parents lawyered up and Sued everyone including the school. They were of the opinion that they should have been warned about the dangerous person Poddar was, which they weren't. Their daughter should have been warned.

The case went all the way up to California Supreme Court which gave birth to the Tarasoff Statutes.

Tarasoff I: The psychiatrist has a duty to warn based on actual subjective prediction of violence.

Tarasoff II: ...Duty to warn AND to protect!

Tarasoff I was actually withdrawn after the psychiatric community raised an uproar about it. Understandably so, because this was an Ethical case and where do we then draw the line on confidentiality?

So the law was reworded in Tarasoff II .

Basically what Tarasoff II is saying is that the psychotherapist after warning must protect the person violence is being threatened again either by confining the person making that threat or informing appropriate authorities to confine.

I remember this because I was asked this and Testamentary Capacity in my Oral Psychiatry Finals when I was writing my final exams in med school.

END.