Following a decision by the Pennsylvania Supreme Court in August, a Pittsburgh child psychiatrist will not be faced with paying major financial damages to the parents of a child she was treating for the consequences of alleged sexual abuse.

That court overturned a lower court verdict in which psychiatrist Judith Cohen, M.D., and the University of Pittsburgh’s Western Psychiatric Institute and Clinic were ordered to pay $272,232 in damages to the parents and child for breaching their duty to the parents and delivering negligent care. The couple and their daughter, a minor when the suit was filed, charged that the psychiatrist and the hospital that employs her were responsible for the harm they suffered as a consequence of claims their daughter made during therapy that they sexually abused her. They also argued that the psychiatrist failed to carry out the duty she owed them since their daughter was a minor during her psychiatric treatment.

The Pennsylvania Supreme Court reversed an Allegheny County civil court ruling—later upheld by a state appeals court—that said a psychiatrist owed a duty to a minor patient’s parents that extended beyond the confidential confines of the psychiatrist-patient relationship.

The original ruling came in 1994, three years after Nicole Althaus confided to a therapist for a cancer support group that she had been the victim of sexual abuse by her father. (Nicole’s mother was being treated for skin and breast cancer, and a teacher recommended the support group to Nicole.) That counselor reported the allegations to the county’s youth services division, which resulted in the arrest of Althaus’s father, Richard, and Nicole’s removal to a foster home. She was 15 years old at the time. On the recommendation of a psychologist, Nicole was referred to Cohen at the Child and Adolescent Sex Abuse Clinic at Western Psychiatric.

As time went on, Nicole embellished and added other people to the sexual-assault scenario, including family, neighbors, and strangers. She eventually claimed that babies to which she gave birth were killed during satanic rituals. One of the couples Althaus included in her story ended up in jail because of her rape accusations.

Because of these charges, her father was arrested three times and her mother twice. Before criminal rape charges could be prepared and processed as a prelude to again arresting her parents, Althaus recanted her story, and all charges against them were dismissed.

After the charges against the Althauses were dismissed, Nicole and her parents sued Cohen and Western Psychiatric, charging the psychiatrist with planting false memories in their daughter and failing to comply with the "duty of care" that the psychiatrist owed them as the young patient’s parents. They also sued the hospital because it employed Cohen. They argued, according to the appeals court’s description of the case, that "Dr. Cohen owed them a duty of care because of her awareness that many of Nicole’s allegations could not be true and because of her knowledge that these allegations were the basis of the criminal proceedings against them."

They contended that although Cohen did not dispute the fact that she believed many of Nicole’s accounts were fabricated, she "made no independent investigation" of these reports, suggesting that Cohen owed them a duty to reveal her skepticism. Doing so, they said, would have prevented their arrest and public humiliation, which occurred during the time Cohen was treating their daughter.

Cohen insisted that her role was purely therapeutic and did not obligate her to get involved in the forensic consequences of Nicole’s false sexual-abuse memories. Her treatment of Nicole, the appeals court noted, focused on her determination that the girl suffered from "a posttraumatic stress disorder and depression secondary to sexual abuse." She chose not to confront Nicole with her suspicions about the veracity of the abuse accounts for fear it would damage the relationship of trust she had built with her young patient. She also backed Nicole’s foster-home placement despite her doubts about the girl’s reports.

The trial and appeals courts agreed with the parents that Cohen failed to comply with the duty of care she owed them. The appeals court stated that "despite the absence of a psychiatrist-patient relationship between the psychiatrist and parents in this case, the psychiatrist owed them a duty of care because the psychiatrist’s actions extended well beyond the psychiatric treatment of the child."

The appeals court indicated that it attached considerable weight to Cohen’s willingness to participate in the early phases of the criminal proceedings against the Althauses, accompanied by her withholding from the court her belief that Nicole’s testimony about the parental abuse was false.

The state supreme court reversed the trial and appeals courts, however, agreeing with Cohen and Western Psychiatric that in fact there is no law that imposes on a psychiatrist treating a youngster for sexual abuse a duty of care to the child’s parents. The justices found no grounds for the negligence charges the parents filed against Cohen and the hospital.

Justice Ronald Castille, writing for the majority, noted, "The therapeutic relationship between Dr. Cohen and Nicole created professional obligations and legal duties that related exclusively to her patient, Nicole." He noted the "special nature of a relationship between a therapist and a child patient," particularly in cases where treatment deals with sexual abuse allegations. "To hold otherwise would create an unworkable conflict of interest for the treating therapist, . . .which would necessarily hinder effective treatment of the child."

While it negated the compensatory damage award to Richard and Cheryl Althaus, it allowed to stand the $58,000 award to Nicole. Following the state supreme court’s reversal, Cohen’s attorney, Jeffrey Wiley, hailed the verdict as critical to the success of psychiatric treatment of children.

"Child psychiatrists know that they can focus solely on treating the child without having to worry about some duty to the alleged abuser," he said.

[Althaus v. Judith Cohen, M.D., and University of Pittsburgh Western Psychiatric Institute and Clinic, Nos. 70 &71 W.D. Appeal Docket 1998, J-32-1999]