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Imposing a duty on mental health providers to warn unnamed "neighbors" about a patient's vague threats of violence would be "utterly untenable" and could "destroy" generally accepted principles about patient privacy and the doctor-patient relationship, an attorney representing a hospital argued Wednesday before the Pennsylvania Supreme Court.

The case stemmed from allegations that mental health providers failed to warn about a patient who had made numerous threats against unnamed "neighbors." The family of a woman ultimately killed by the patient argued the providers had a duty to warn at least those on the patient's floor about the threat.

Dickie, McCamey & Chilcote attorney John Conti, who is representing UPMC Presbyterian Shadyside, told the justices during the oral argument session in Maas v. UPMC Presbyterian Shadyside that the threat's use of the term "neighbor" was too "amorphous and vague," and the defendants had no way of knowing specifically who it applied to.

"How is it possible to warn all tenants, workers, or family members who happened to be there?" Conti asked, suggesting the landlord would need to put up signs with the potentially violent patient's name and picture on it, since many would not otherwise know who the person was. "It breaks down with the slightest contact with reality."

However, Jon Perry of Rosen Louik & Perry, who is representing the plaintiffs, said the patient's medical record showed repeated and persistent violent threats against persons living nearby, and argued that providing at least a general warning would have been reasonable.

"Had she received a warning under her door, she would never have, by herself, alone in that apartment, opened the door and let him in," Perry said.

Perry is representing the family of Lisa Maas, a woman who was attacked and killed by Terrence Andrews. Andrews, according to court records, was receiving mental health treatment and lived four doors down from Maas in the same western Pennsylvania apartment complex. Just days before, Andrews had informed the defendants of homicidal ideations against one of his neighbors, according to court records. Maas died as a result of multiple stab wounds from scissors. Andrews had previously revealed during an ER visit to Western Psychiatric Institute and Clinic that he planned to kill one of his neighbors in that manner.

Maas' mother, Laura Maas, acting as administratrix of her daughter's estate, filed suit. She argued the defendants had a duty to warn Andrews' neighbors about the threats he had made during several ER visits and phone contacts with the health care provider.

An Allegheny County trial judge found that a reasonable jury could find that "the tenants residing on Andrews' floor in Hampshire Hall were a readily identifiable group of people to whom [the UPMC] defendants owed a duty to warn." A three-judge panel of the state Superior Court agreed, ruling last June that the defendants—UPMC Presbyterian Shadyside, which does business as Western Psychiatric Institute and Clinic; Western Psychiatric Institute and Clinic; Dr. Michelle Barwell; and Western Psychiatric Institute and Clinic Adult Community Treatment Team—had a duty to warn the neighbors of a mentally ill patient that he had threatened to kill one of them, even though he hadn't specified which one.

During the argument session in Pittsburgh on Wednesday, the justices focused numerous questions on whether the threats could be viewed as sufficiently narrow to merit a duty to warn.

"It's contextualized to this case, and in this case, his neighbors were arguably readily identifiable," Justice Debra Todd said, during Conti's portion of the argument.

Conti, however, said the lower court's determination was "hindsight bias," and based on the false notion that violence can always be preventable. There has to be a limiting principal, Conti argued, and accepting the plaintiff's position would essentially create a strict liability standard where if any violent event occurred, a plaintiff could argue that the mental health providers failed to either warn or ask the right questions to more readily identify the object of the threat.

During Perry's rebuttal argument, Justice Max Baer agreed that what the plaintiff was asking for is a "tough duty to put on" physicians.

Perry, however, urged the justices to look at Andrews' mental health record, and countered that given the nature of the threats, the providers had a duty to warn.

"How can they possibly say she wasn't reasonably identifiable when they made no effort to determine whether she was reasonably identifiable," he said.