Spokane case raises questions about the extent to which a doctor is responsible for his patient’s subsequent actions.

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The family of a Spokane woman who was murdered along with her son can pursue a lawsuit over whether the killer’s psychiatrist should have done more to protect them, the Washington Supreme Court held in a case with implications for mental-health professionals around the state.

Rebecca Schiering and one of her sons, Phillip, were shot by her ex-fiance, Jan DeMeerleer, in 2010. DeMeerleer, who also wounded another of Schiering’s sons in the attack, then returned to his own home and killed himself.

Schiering’s family sued the killer’s psychiatrist, Dr. Howard Ashby, and Spokane Psychiatric Clinic, alleging they were negligent in their treatment of DeMeerleer and that they should have done more to protect the victims. Ashby knew his patient had previously expressed homicidal and suicidal ideas, but found no “real clinical problem” in their most recent meeting, three months before the killings.

In a 6-3 opinion, the Supreme Court held Thursday that the lawsuit can go forward. The majority said mental-health professionals must act with reasonable care to identify and mitigate the dangerousness of psychiatric patients.

The opinion rejected an argument from the defendants and from the Washington State Psychological Association that under state law, mental-health professionals are only liable if they fail to act when a patient has communicated an actual threat against an identifiable target. DeMeerleer had never expressed such threats against Schiering or her children.

Writing for the majority, Justice Mary Fairhurst noted that “mental-health professionals face an incredibly difficult task in ascertaining whether a patient will act violently.” But, she said, when they have an ongoing relationship with a patient they have a “duty of reasonable care to act consistent with the standards of the mental health profession, in order to protect the foreseeable victims of his or her patient.”

At issue is whether Ashby acted in accordance with professional standards in failing to warn Rebecca Schiering or law enforcement of any potential danger or to take other actions that might have protected them. That could have included probing more deeply about whether DeMeerleer felt homicidal, requiring better monitoring to ensure he was taking his medication, or even having him involuntarily committed to a psychiatric facility.

In a friend-of-the-court brief, the psychological association warned that requiring mental-health professionals to act based on unscientific and unreliable assessments of future danger could bring a host of problems as they seek to avoid liability.

For example, they could become too quick to order involuntary psychiatric commitments, harming the rights of patients and further overburdening the state’s mental-health system, the group said. Or they could become too likely to warn people about the possible danger posed by a patient — jeopardizing provider-patient confidentiality and making it less likely patients will be forthcoming.

“It’s a very difficult duty that they’re proposing, that anybody that works in the mental-health industry will now have,” said David Kulisch, a lawyer for Spokane Psychiatric Clinic. “I’m afraid that for some people the default’s going to be that rather than face liability, it’ll be a lot easier to just commit them.”

In his dissent, Justice Charles Wiggins agreed.

“Broadening the duties and potential liabilities of these professionals threatens to chill critical mental health services, while sparking unnecessary litigation,” he wrote.

Ashby treated DeMeerleer for about nine years. He knew that in the 1990s, DeMeerleer was hospitalized because he was suicidal, and that after the breakup of his marriage in 2003 he expressed suicidal and homicidal thoughts. DeMeerleer, who was bipolar, also had a poor record in staying on his medications.

DeMeerleer began dating Schiering in 2005, and in 2010, with the relationship ending, he made an appointment with Ashby.

“He states when depressed he can get intrusive suicidal ideation, not that he would act on it but it bothers him,” Ashby wrote in his notes of that meeting. “At this point it’s not a real clinical problem but we will keep an eye on it.”

Ashby decided to continue a medication regimen but took no other actions. A forensic psychiatrist hired by Schiering’s mother, Beverly Volk, called that unreasonable.

“Dr. Ashby knew this patient very well,” said Ashby’s attorney, Bob Sestero. “He did assessments each and every visit, and the last visit showed the patient had good insight into his thought processes, appeared rational and was denying any kind of intent to harm anyone. We’ll have to show the jury that what he did was horribly unexpected.”

A toxicology report found that at the time of the killings, DeMeerleer was off his medications.