WOOTON, J.

Benjamin L. Bailey, Esq., BAILEY GLASSER, LLP, Charleston, West Virginia, P. Gregory Haddad, Esq., Travis A. Prince, Esq., BAILEY GLASSER, LLP, Morgantown, West Virginia, Counsel for Petitioner.

Roberta F. Green, Esq., Justin M. Kearns, Esq., Shuman McCuskey Slicer PLLC, Charleston, West Virginia, Counsel for Respondent, Steven Corder, M. D.

Cy A. Hill, Jr., Esq., Ashley W. French, Esq., Cipriani & Werner, P. C., Charleston, West Virginia, Counsel for Respondent, Melanie Bassa, M. A.

Patrick S. Casey, Esq., Sandra M. Chapman, Esq., CASEY & CHAPMAN, PLLC, Wheeling, West Virginia, Counsel for Respondents Martha Donahue, N. P., Northwood Health Systems, Inc., and Mid-Valley Healthcare Systems, Inc.

WOOTON, J.: This is an appeal from the Circuit Court of Ohio County's August 26, 2020, order dismissing the claim of petitioner Christopher Morris, individually and as Administrator of the Estate of Amy Christine Wade (hereinafter "petitioner") against respondents Steven Corder, M. D., Melanie Bassa, M. A., Martha Donahue, N. P., Northwood Health Systems, Inc., Mid-Valley Healthcare Systems, Inc., and John Does 1-5 (hereinafter collectively "respondents") pursuant to Rule 12(b)(6) of the West Virginia Rules of Civil Procedure. The circuit court found that petitioner's claims for medical negligence are barred by his failure to allege that his decedent was "in the custody" of respondents at the time of her suicide.

After careful review of the briefs of the parties, their oral arguments, the appendix record, and the applicable law, we find that the circuit court erred in concluding that this Court's precedent requires a decedent to be in the "custody" of a health care provider to assert a claim for deviations from the standard of care proximately resulting in a decedent's suicide. Accordingly, we reverse the circuit court's dismissal of the case and remand for further proceedings.

I. FACTS AND PROCEDURAL HISTORY

In his complaint, petitioner alleges that his decedent, Amy Christine Wade (hereinafter "Ms. Wade"), received behavioral and mental health treatment from respondents for more than ten years, from January 1, 2008 through June 2018. She was diagnosed with paranoid schizophrenia, borderline mental functioning, and panic disorder agoraphobia and treated with a combination of pharmaceuticals, clinical management, and counseling by respondents.

Petitioner alleges that on or around February 28, 2018, Ms. Wade's psychiatric condition began to rapidly deteriorate. Treatment notes thereafter allegedly reflect an increase in suicidal thoughts, auditory hallucinations, threatening visual hallucinations, and general emotional instability. On April 25, 2018, Ms. Wade allegedly made irrational claims about the death of her grandson and reported increased sadness, crying spells, decreased sleep, and increased worrying. On June 11, 2018, Ms. Wade's providers noted that she had a disheveled appearance, reported that she "doesn't sleep anymore," that her "life has been hell," and that she had three suicidal ideations in the week prior. On June 20, 2018, Ms. Wade reported that she had been in "such a state of panic" that she presented for treatment at an Emergency Room. Ms. Wade committed suicide on June 30, 2018.

Petitioner served a notice of claim and screening certificate of merit on each respondent pursuant to the Medical Professional Liability Act, West Virginia Code §§ 55-7B-1 through - 12 (2015 & Supp. 2021) ("MPLA") and filed his complaint alleging that the individual respondents deviated from the standard of care in their treatment of Ms. Wade. More specifically, petitioner alleges that despite Ms. Wade's increasingly unstable presentation and reports of suicidal ideation, no changes were made to her treatment regimen—including medications, follow-up appointments, and specialist evaluations—nor was she referred for hospitalization in a crisis stabilization unit or admission to an inpatient psychiatric unit.

In response to the complaint, all respondents filed motions to dismiss pursuant to Rule 12(b)(6) of the West Virginia Rules of Civil Procedure, arguing that Ms. Wade's suicide constituted an intentional intervening act and precluded liability against respondents. In evaluating the allegations in the complaint, the circuit court highlighted that "[a]t no time was [Ms. Wade] in the voluntary or involuntary custody of any of the Defendants during the relevant time frame[ ] ... [and that] all services were rendered on an out-patient basis." Citing this Court's decision in Moats v. Preston County Commission , 206 W. Va. 8, 521 S.E.2d 180 (1999) and a subsequent memorandum decision, the circuit court found petitioner's failure to allege that respondents were "custodial caretaker[s]"—which the court perceived to constitute the "one exception to the general bar on suicide claims"—was fatal to her cause of action. The circuit court dismissed the complaint pursuant to Rule 12(b)(6) due to the complaint's "fail[ure] to allege that [Ms. Wade] was in the custody of any [respondent] at the time of her suicide." This appeal followed.

II. STANDARD OF REVIEW

"Appellate review of a circuit court's order granting a motion to dismiss a complaint is de novo. " Syl. Pt. 2, State ex rel. McGraw v. Scott Runyan Pontiac-Buick, Inc. , 194 W. Va. 770, 461 S.E.2d 516 (1995). With this standard in mind, we proceed to the parties’ arguments.

III. DISCUSSION

Although petitioner asserts three separate assignments of error, this case presents a relatively narrow issue of law regarding the scope of this Court's holding in Moats . The question presented is whether this Court's precedent holds that a negligence-based claim for professional liability for failure to prevent suicide is restricted to only those defendants who had a "custodial" relationship with the decedent. Petitioner argues that the circuit court misread Moats and that nothing in our caselaw limits a cause of action for failure to prevent suicide to only "custodial caretakers." He argues further that such a reading of our precedent would effectively void any duty of care to outpatient mental health patients, thereby nullifying the requirement of the MPLA that health care providers conform to the applicable standard of care. Respondents argue that it is petitioner who seeks to expand the law of this state as it pertains to "non-custodial suicide." Respondents urge that such an expansion is unsound from a public policy standpoint and vitiates the Court's long-standing treatment of suicide as an intervening cause barring liability.

We begin with an examination of Moats . In Moats , plaintiff's decedent was involuntarily committed to the custody of the Preston County Sheriff's Office for transfer to William Sharpe Hospital for a mental health evaluation, having attempted suicide the day prior. 206 W. Va. at 11, 521 S.E.2d at 183. While at the Preston County Jail office awaiting transfer, the decedent consumed bathroom cleaner which resulted in her death eight months later. Id. Charles A. Moats, on behalf of the decedent's estate, brought a wrongful death action against the county commission and a mental health evaluator, who testified in the decedent's mental hygiene hearing and left her in the jail office while he went to retrieve her commitment order. Id. In one of several certified questions to this Court, the circuit court queried whether the fact that the decedent committed suicide was an outright bar to Moats’ claims. Id. The Court began by recognizing that despite the fact that suicide has "generally" been treated as an intervening cause, "courts have allowed such actions where the defendant is found to have actually caused the suicide or where the defendant is found to have had a duty to prevent the suicide from occurring." Id. at 16, 521 S.E.2d at 188. Elaborating on the duty exception, the Court observed again that "generally" the exception applies where there is a "duty of custodial care" and the defendant knows that the potential for suicide exists but fails to take preventative measures. Id. Pertinent to the particular facts in Moats , the Court further noted that this exception had been applied to "jails, hospitals, reform schools, and others having actual physical custody and control over such persons." Id. This discussion forms the centerpiece of the circuit court and respondents’ insistence that only "custodial" suicide is actionable.

Importantly, however, the foregoing discussion from Moats is merely dicta. In answering the certified question, the Moats Court held as follows in a properly issued syllabus point:

Recovery for wrongful death by suicide may be possible where the defendant had a duty to prevent the suicide from occurring. In order to recover, the plaintiff must show the existence of some relationship between the defendant(s) and the decedent giving rise to a duty to prevent the decedent from committing suicide. Generally , such relationship exists if one of the parties, knowing the other is suicidal, is placed in the superior position of caretaker of the other who depends upon that caretaker either entirely or with respect to a particular matter.

206 W. Va. 8, 521 S.E.2d 180, syl. pt. 6 (emphasis added). Notably absent from the Court's syllabus point is any reference to a "custodial" relationship, be it as a caretaker or otherwise. Rather, the syllabus point expressly requires only "some relationship" which would give rise to a duty to prevent suicide. Id. (emphasis added). Further, the syllabus point's elaboration on the type of "caretak[ing]" which would exemplify such relationship certainly does not preclude non-custodial "caretaker[s]"; rather it describes somewhat broadly the degree of caretaking required, without reference to the setting or construct. Therefore, the circuit court's conclusion that Moats holds that a custodial relationship is required to advance a duty-based (as opposed to causation-based) suicide claim is in error.

Respondents insist that the Moats Court intended to exclusively sanction custodial negligence as an actionable form of "failure to prevent" suicide claim. However, it is the breadth of the syllabus point's language—in the face of specifically delineated instances of liability and/or other criteria which it easily could have adopted—which best demonstrates Moats ’ resistance to being construed as narrowly as respondents would urge. Importantly, Moats ’ discussion of the types of duty-based causes of action for failure to prevent suicide was plainly not intended to be comprehensive. The suicide at issue in Moats occurred while the decedent was in custody in a jail office while awaiting transport to a secure facility. Accordingly, as preface to its holding, Moats discusses certain custodial , duty-based scenarios in which liability has been imposed: "[T]his exception has been applied to jails, hospitals, reform schools, and others having actual physical custody and control over such persons." Id. at 16, 521 S.E.2d at 188.

This discussion is directly derived from an outline of duty-based "failure to prevent" suicide scenarios described in McLaughlin v. Sullivan , 123 N.H. 335, 461 A.2d 123, 125 (1983). Presumably because it was not germane to the factual scenario presented in Moats , the Court did not include the McLaughlin court's discussion of a second type of defendant with whom a duty to prevent suicide may lie: mental health professionals. The remainder of the excerpt from McLaughlin elaborates:

Specifically, this duty has been imposed on: ... (2) persons or institutions such as mental hospitals, psychiatrists and other mental-health trained professionals, deemed to have a special training and expertise enabling them to detect mental illness and/or the potential for suicide, and which have the power or control necessary to prevent that suicide.

Id. There is no reference to "custody" contained within the description of this category of defendant.

It is significant that the syllabus point issued in Moats did not attempt to strictly limit liability to either of the specific categories described in McLaughlin by utilizing the wording or characterizations contained therein. Instead, the original language of the syllabus point appears aimed at broadly synthesizing these two categories of duty-based suicide claims, while allowing for additional unspecified scenarios which fulfill the relationship criterion and thereby justify an imposition of a duty. The syllabus point draws its focus to the degree of the caretaking relationship and the caretaker's knowledge that the individual is "suicidal" for purposes of imposition of duty. Accordingly, the syllabus point is crafted to be applicable to a broad range of scenarios both fairly encompassing those specifically described in McLaughlin , as well as those that fall outside of its contemplation but nonetheless factually give rise to an actionable duty.

Our conclusion that the circuit court misread the decision in Moats is not only consistent with this Court's stated syllabus point, but also consistent with the type of claims previously found actionable here and elsewhere. See Martin v. Smith , 190 W. Va. 286, 438 S.E.2d 318 (1993) (upholding verdict against psychiatrist where decedent committed suicide after being released from facility on eight-hour pass); Rodriguez-Escobar v. Goss , 392 S.W.3d 109, 113 (Tex. 2013) (permitting action against psychiatrist for failure to prevent suicide where "suicide probably would not have occurred if the decedent had been hospitalized."); Perez v. United States, 883 F. Supp. 2d 1257, 1286 (S.D. Fla. 2012) ("[I]t would be peculiar, and seemingly contrary to the intent of Florida's law on medical negligence, to absolve a treating psychiatrist of liability for all negligent acts simply because the patient is being seen on an outpatient basis." (footnote omitted)); Peterson v. Reeves , 315 Ga.App. 370, 727 S.E.2d 171 (2012) (recognizing psychiatrist's failure to involuntarily commit patient may form basis of malpractice action); Kockelman v. Segal , 61 Cal.App.4th 491, 71 Cal. Rptr. 2d 552, 561 (1998) (holding psychiatrist's duty of care "exists whether the patient is hospitalized at the time or not"); Edwards v. Tardif , 240 Conn. 610, 692 A.2d 1266, 1270 n.7 (1997) (rejecting argument that psychiatrist liability for suicide is limited to "when patient is in the physician's custody"). Moreover, our interpretation of Moats is consonant with sound public policy and common sense. Importantly, petitioner herein alleges that respondents deviated from the applicable standard of care by, inter alia, failing to admit Ms. Wade to a crisis stabilization facility or in-patient psychiatric facility. It would defy logic to permit a health care provider to evade liability for failing to properly admit a patient on the basis that the patient was not admitted. Compare Bexiga v. Havir Mfg. Corp. , 60 N.J. 402, 290 A.2d 281, 286 (1972) (concluding it would be "anomalous to hold that defendant has a duty ... but a breach of that duty results in no liability for the very injury the duty was meant to protect against."); see also Hoeffner v. The Citadel , 311 S.C. 361, 429 S.E.2d 190, 193 (1993) (same).

In that regard, respondents attempt to distinguish our previous case of Martin . See 190 W. Va. 286, 438 S.E.2d 318. In Martin , a verdict against a psychiatrist who improperly released a patient who then committed suicide was upheld; respondents argue that the deviation from the standard of care in Martin occurred at the "custodial" level, i.e. when the decedent was in the facility. Clearly, however, a negligent failure to pursue efforts to admit a patient for inpatient care or monitoring is merely the flip side of the "negligent release" coin. Both raise the question of whether the health care provider has "failed to exercise that degree of care, skill and learning required or expected of a reasonable, prudent health care provider in the profession or class to which the health care provider belongs acting in the same or similar circumstances[.]" W. Va. Code § 55-7B-3(a)(1) (2003). As the Kockelman court observed:

[P]sychiatrists owe a duty of care, consistent with standards in the professional community, to provide appropriate treatment for potentially suicidal patients, whether the patient is hospitalized or not. There is no reasonable basis for the distinction defendants seek to impose. Indeed, it would seem almost self-evident that doctors must use reasonable care with all of their patients in diagnosing suicidal intent and implementing treatment plans.

71 Cal. Rptr. 2d at 558 ; see also Chirillo v. Granicz , 199 So. 3d 246 (Fla. 2016) (recognizing mental health professional's duty to treat outpatient decedent who committed suicide defined by applicable standard of care).

Finally, we dispense with respondents’ contention that a reversal of the circuit court's ruling would abrogate our purported prior determination that "as a matter of law , non-custodial suicide constitutes an intervening, superseding act that undercuts any attachment of duty." (emphasis added). Respondents cite no authority for this boldly stated proposition and, in fact, the very case upon which they rely— Moats —plainly undermines it. Aside from dicta making a general, historical observation that suicide has been treated as an intentional act, this Court has never found it to be an outright bar as a matter of law—hence, the certified question to that effect in Moats . In fact, shortly after Moats , in a Russian roulette case (which was analyzed as akin to suicide), the Court reiterated that it "has consistently dealt with the determination of intervening cause within the framework of the proximate cause analysis and has relegated the task of resolution of these matters to the jury[.]" Harbaugh v. Coffinbarger , 209 W. Va. 57, 65, 543 S.E.2d 338, 346 (2000). The Harbaugh Court paused to "emphasize[ ] the significant role of the concept of foreseeability in the determination of intervening cause" by citing syllabus point thirteen of Anderson v. Moulder , 183 W. Va. 77, 394 S.E.2d 61 (1990) : "A tortfeasor whose negligence is a substantial factor in bringing about injuries is not relieved from liability by the intervening acts ... if those acts were reasonably foreseeable by the original tortfeasor at the time of his negligent conduct." Id. at 64, 543 S.E.2d at 345.

We therefore find that the circuit court erred by concluding that our precedent contains a "custodial" prerequisite for claims based on deviations from the standard of care proximately resulting in a patient's suicide, and accordingly that petitioner's claims were barred as a matter of law.

IV. CONCLUSION

For the reasons set forth above, we reverse the August 26, 2020, order of the Circuit Court of Ohio County and remand for further proceedings.

Reversed and remanded.

CHIEF JUSTICE JENKINS and JUSTICE ARMSTEAD dissent and reserve the right to file dissenting opinions.

Armstead, Justice, dissenting, joined by Chief Justice Jenkins :

The circumstances of this matter are tragic. The family members of the decedent, Ms. Wade, are understandably grief-stricken. Although I am sympathetic to Petitioner's enormous loss, from a legal standpoint I agree with the circuit court's ruling that Petitioner's claims for medical negligence are barred by his failure to allege that the decedent was "in the custody" of Respondents at the time of her suicide. Therefore, I respectfully dissent from the majority's conclusion that the circuit court erred by granting Respondents’ motion to dismiss Petitioner's claims.

This Court has long held that "negligence actions seeking damages for the suicide of another have generally been barred because the act of suicide is considered deliberate and intentional, and therefore, an intervening act that precludes a finding that the defendant is responsible[.]" Moats v. Preston Cnty. Comm'n , 206 W. Va. 8, 16, 521 S.E.2d 180, 188 (1999). The Court in Moats set forth the narrow circumstance in which a plaintiff may assert a claim for wrongful death by suicide:

Recovery for wrongful death by suicide may be possible where the defendant had a duty to prevent the suicide from occurring. In order to recover, the plaintiff must show the existence of some relationship between the defendant(s) and the decedent giving rise to a duty to prevent the decedent from committing suicide. Generally, such relationship exists if one of the parties, knowing the other is suicidal, is placed in the superior position of caretaker of the other who depends upon that caretaker either entirely or with respect to a particular matter.

Id. at Syl. Pt. 6.

The circuit court cited this syllabus point and stated, "Plaintiff's Complaint does not allege that Defendants were in a relationship that gave rise to a duty to prevent the suicide such as that of a custodial caretaker." Further, the circuit court noted that this Court addressed the exception to our general bar on wrongful death by suicide claims in a recent memorandum decision, Hull v. Nasher-Alneam, No. 18-1028, 2020 WL 882087 (W. Va. Feb. 24, 2020) (memorandum decision), cert. denied , No. 20-1818, ––– U.S. ––––, 142 S.Ct. 117, 211 L.Ed.2d 37 (U.S. Oct. 4, 2021) (" Hull ").

In Hull , issued approximately six months before the circuit court granted Respondents’ motion to dismiss, this Court provided:

Consistent with Moats , the circuit court in this matter found that petitioners’ malpractice claims were barred, unless they fell within a recognized exception to the general rule barring claims based upon suicide. The circuit court further held that this Court has recognized only one narrow exception to the general rule "where the defendant is found to have had a duty to prevent the suicide from occurring" which applies to "someone who has a duty of custodial care, knows that the potential for suicide exists, and fails to take the appropriate measures to prevent the suicide from occurring." [quoting Moats , 206 W. Va. at 16, 521 S.E.2d at 188.] This exception has been applied to jails, hospitals, reform schools, and others having physical custody and control over the persons.

In the instant case, the circuit court found, as a matter of law, that petitioners’ claims do not fall within the narrow exception recognized in Moats . To fit within

this exception, petitioners would have had to allege facts to satisfy each of these elements: custodial care, knowledge of the potential for suicide, and failure to take appropriate measures to prevent the suicide from occurring.

Id. , 2020 WL 882087, at *3 (emphasis added).

Relying on this analysis, the Court in Hull concluded:

The complaint does not allege that Mr. Hull was in the custodial care of respondents at the time he committed suicide, nor did petitioners allege that Mr. Hull had ever been in the custodial care of respondents.... Inasmuch as petitioners allege no facts that would cause this case to fall within the single, narrow exception to the general rule, we concur with the circuit court's well-founded conclusion that Mr. Hull's suicide bars petitioners’ claims.

Id.

I believe the circuit court correctly determined that under Moats , and the Hull memorandum decision issued by this Court in February of 2020, Petitioner's claims for medical negligence are barred by his failure to allege that the decedent was "in the custody" of Respondents at the time of her suicide. While Hull was a memorandum decision, rather than a signed opinion, the issue of whether a plaintiff asserting a claim for wrongful death by suicide must establish that the decedent was in the custodial care of a defendant was squarely before the Court and addressed in that case.

The majority's discussion of Hull is limited to a footnote in which it attempts to distinguish Hull from the instant case. The facts of the two cases are not identical; however, there is no dispute that this Court addressed custodial care in the context of a wrongful death by suicide claim in Hull . The majority's departure from our ruling in Hull is not supported under the doctrine of stare decisis.

In syllabus point 2 of Dailey v. Bechtel Corp. , 157 W. Va. 1023, 207 S.E.2d 169 (1974), this Court held that "[a]n appellate court should not overrule a previous decision recently rendered without evidence of changing conditions or serious judicial error in interpretation sufficient to compel deviation from the basic policy of the doctrine of stare decisis, which is to promote certainty, stability, and uniformity in the law." (emphasis added). Additionally, we have observed that

[s]tare decisis ... is a matter of judicial policy.... It is a policy which promotes certainty, stability and uniformity in the law. It should be deviated from only when urgent reason requires deviation.... In the rare case when it clearly is apparent that an error has been made or that the application of an outmoded rule, due to changing conditions, results in injustice, deviation from that policy is warranted.

Woodrum v. Johnson , 210 W. Va. 762, 766 n. 8, 559 S.E.2d 908, 912 n. 8 (2001) (internal quotations and citations omitted).

This Court's ruling in Hull was "recently rendered"—it was decided six months before the circuit court granted the motion to dismiss. Moreover, I see no changing conditions or serious judicial error in interpretation sufficient to compel deviation from our rulings in Moats and Hull .

Finally, a number of courts outside of our jurisdiction have concluded that a plaintiff asserting a wrongful death by suicide claim must establish that a custodial relationship existed between the decedent and a defendant. As one court recognized, "a review of cases in other jurisdictions advances only one type of special relationship that consistently imposes a duty on an actor to prevent another's suicide, namely a relationship predicated on a custodial relationship." Lee v. Corregedore , 925 P.2d 324, 330 (Hawaii 1996) (Veteran's Services outpatient counselor with history of treatment and close personal knowledge of patient had no duty to prevent that patient's suicide); see also McLaughlin v. Sullivan , 123 N.H. 335, 461 A.2d 123, 125 (1983) (suggesting that liability against a psychiatrist would be inappropriate over a non-hospitalized patient); Christian v. Counseling Res. Assoc., Inc. , 2014 WL 4100681, at *7-10 (Del. Super. July 16, 2014) (no special relationship between outpatient primary care physician and mental health counselor and decedent because no custody or control); Waybright v. Frederick Cty., MD , 528 F.3d 199, 207 (4th Cir. 2008) (applying Maryland law and stating, "a special relationship is all but synonymous with a custodial relationship." (citation omitted)); Watson v. Adams , 2015 WL 1486869, at *7 (D.S.C. Mar. 31, 2015) ("Both South Carolina and federal courts have rejected attempts to extend the duty to prevent suicide beyond the period of custody.").

Based on the foregoing, I respectfully dissent from the majority's decision to reverse the circuit court's order granting Respondents’ motion to dismiss.