## Facts

- Joseph Evans, a 27-year-old outpatient of a state psychiatric facility, fatally stabbed Albert R. Schrempf at Schrempf’s workplace on December 9, 1981.
- Evans had been hospitalized in state psychiatric institutions multiple times between 1979 and 1981, often after violent conflicts with family, property damage, and attempted assaults, but without prior serious personal injury.
- Evans reported command hallucinations and was variably diagnosed as manic depressive (hypomanic) or paranoid schizophrenic.
- Evans often improved with psychotherapy and medication but was poorly compliant with outpatient treatment and medications.
- In September 1981, Evans presented to the state facility reporting delusions and fear of harm; a state psychiatrist determined Evans did not then pose sufficient danger to justify inpatient confinement.
- Evans was discharged to a monitored outpatient clinic for medication management and regular psychiatric follow-up.
- Shortly before the homicide, the treating psychiatrist noted incomplete compliance but also that Evans maintained part-time employment without incident and had completed a trial period at the same workplace.
- Schrempf’s estate brought a wrongful death claim alleging the State negligently failed to recommit Evans and thereby failed to prevent a foreseeable killing.

## Issues

1. Whether the State could be held liable for a third party’s criminal act absent a “special relationship” between the State and the victim.
2. Whether the State is liable for malpractice where a psychiatrist’s inpatient-versus-outpatient decision fell within accepted professional medical judgment, despite a later violent act.

## Decision

- The Court of Appeals reversed and dismissed the claim.
- The court held liability could not be based on the psychiatrist’s decision not to recommit Evans because that decision was within accepted medical practice and protected professional judgment.
- The court concluded the trial court improperly treated an adverse outcome and hindsight (“should have done something”) as proof of negligence.
- Having resolved the case on medical-malpractice grounds, the court declined to decide whether a “special relationship” was required to impose a duty to protect the victim.

## Legal Principles

- Medical malpractice requires proof of a departure from accepted medical practice; a poor outcome does not itself establish negligence.
- A physician is not negligent merely because another competent physician would have chosen a different treatment option.
- When a clinician selects among medically acceptable alternatives, the choice is an exercise of professional judgment and is not actionable absent a proven deviation from accepted standards.
- In claims against the State based on psychiatric treatment and release/retention decisions, expert disagreement may indicate the decision was within the range of accepted practice; liability cannot rest on hindsight or outcome alone.
- Courts may dispose of third-party injury claims arising from patient management by applying ordinary malpractice standards without reaching broader governmental-duty questions.

## Conclusion

The court held the State was not liable for the homicide because the treating psychiatrist’s decision to manage the patient as an outpatient was supported by acceptable professional judgment and did not constitute a departure from accepted medical practice, making it unnecessary to decide any broader duty-to-protect theory.


Schrempf v. State, 66 N.Y.2d 289 (N.Y. 1985)