Case:

In August 2012, K.I., a patient diagnosed with schizophrenia, was reportedly experiencing auditory hallucinations that were commanding him to kill himself. He was emergently admitted to Walden Behavioral Care, a psychiatric treatment facility in Massachusetts. K.I. was subsequently committed to the facility for a three-day evaluation period, during which he was examined and treated by psychiatrist David Brendel, who filed a petition for K.I.’s continued commitment pursuant to Mass. Gen. Laws ch. 123, § 7,8 (2012), which states that a superintendent of a facility may petition for commitment and retention of any patient at said facility if the superintendent has determined that failure to hospitalize would create the likelihood of serious harm as a result of mental illness.

K.I. stated that he was never informed that his communications with his treating psychiatrist may be admissible in legal proceedings. He filed a motion to exclude Dr. Brendel’s testimony, maintaining that his statements were protected by clinician-patient privilege. Two exceptions to this privilege outlined in the statute were raised in this case. The first exception, Mass. Gen. Laws ch. 233, § 20B(a)(2012), states that privilege shall not apply if a clinician, in the course of his diagnosis or treatment of the patient, determines that the patient is in need of hospitalization for mental illness or that there is a threat of an imminent, dangerous act of the patient against himself or another person. The second exception, Mass. Gen. Laws ch. 233, § 20B(b)(2012), states that privilege shall not apply if a judge finds that a patient, after having been informed that the communications would not be privileged, has made statements to the clinician during the course of a court-ordered examination that were relevant to the patient’s mental illness.

K.I. asserted that the only exception that may be applicable to his case was the latter exception regarding court-ordered examinations. He argued that, because he had not been warned about the nonconfidential nature of his conversations with Dr. Brendel, the doctor’s testimony should be excluded. The judge of the district court denied the motions, determining that the privilege was overcome by the first exception regarding imminent harm.

During the commitment hearing, Dr. Brendel testified that K.I. had made statements that he was hearing voices telling him to kill himself with an overdose of oxycodone. K.I. also indicated that he had access to oxycodone and that he intended to kill himself in this manner after discharge from the hospital. Dr. Brendel therefore testified that K.I. posed an imminent and serious risk of harming himself because of his mental illness if discharged from the hospital. The district court judge ordered K.I. to be committed to Walden Behavioral Care for six months. After two appeals, the original judgment by the district court was upheld.

Questions: 

1.    What forensic laws/rules are involved in this case?

2.    What ethical principles are involved in this case? Are there any ethical principles violated and is it justified?