Liability for a patient's homicide

By Charles Patrick Ewing, JD, PhD
State University of New York at Buffalo

In January, 1995, Wendell Williamson, a law student at the University of North Carolina, appeared on a busy Chapel Hill street dressed in a camouflage jacket, carrying an M-1 rifle, and wearing a knapsack filled with 600 rounds of ammunition. Within minutes, he shot and killed two strangers, then wounded a police officer. Tried before a jury for first-degree murder, Williamson-a former Eagle scout, college honor student and high school student council president-was diagnosed as suffering from paranoid schizophrenia, found not responsible for the killings by reason of insanity and committed to a state hospital. In October, 1998, in a controversial verdict, a civil jury found psychiatrist Myron Liptzin negligent in his treatment of Williamson before the killings. The jury awarded Williamson $500,000 in damages.

Liptzin treated Williamson six times from March until May of 1994 at the University of North Carolina Student Health Service, to which Williamson was referred after he disrupted a law class with claims to be telepathic. Liptzin diagnosed Williamson as suffering from a grandiose delusional disorder and prescribed an antipsychotic medication. Williamson took the medication, his mental status improved, and he completed the semester. In May, Liptzin, who was about to retire, suggested that Williamson seek further psychiatric care at a clinic in his hometown or return to the UNC Student Health Service.

Williamson returned home for the summer and ceased taking the medication because he felt physically better without it. That fall he returned to the college town and eventually decompensated. The following January, Williamson went on the shooting rampage that left two people dead and led to his insanity acquittal and commitment to the state hospital.

At issue in the civil malpractice trial were three questions: 1.) Was Liptzin negligent? 2.) Did his negligence lead to a foreseeable harm? And 3.) Was Williamson guilty of contributory negligence? After a lengthy trial and two and a half days of deliberation, the jury decide that Liptzin was negligent and Williamson was not. Jurors explained that their finding hinged largely upon the psychiatrist's failure to refer Williamson to a specific mental health-care provider and his failure to sufficiently educate Williamson about the severity of his illness. One juror said the jury believed Liptzin should have foreseen the possibility that Williamson might become violent.

The jurors rejected Liptzin's argument that Williamson was at fault for not taking the antipsychotic medication as prescribed by the psychiatrist. In accord with the judge's instructions, jurors said they held Williamson to the lower standard of a reasonable person of like mental capacity (i.e., one suffering from a serious and debilitating mental disorder) and thus found no negligence on his part.

The state has sought to place a lien on the award to help pay for treatment Williamson has received at taxpayers' expense. Liptzin has asked the court to overturn the verdict or to order a new trial. Meanwhile, the verdict has been criticized by mental health professionals, many of whom find no fault with the way Liptzin handled the case. Some say there was no way to predict Williamson's acts. Others add that the verdict underestimates the difficulty of treating psychotic patients and persuading them to remain on medication. The verdict, some say, may deter mental health professionals from treating the most seriously mentally ill, and may deter some patients from seeking treatment out of fear that the professionals may involuntarily hospitalize them to avoid the liability imposed by the jury in this case.

Given the state of the art in predicting dangerousness and the rather low base rate of violence, even among psychotic individuals, critics of the jury's verdict are probably correct in asserting that, without more evidence, Liptzin could not have reasonably foreseen that Williamson's illness would culminate in violence, much less homicide. Moreover, given the high rate of noncompliance with medication among nonhospitalized psychotic patients, it seems unfair to hold a prescribing professional liable when a patient voluntarily ceases medication and decompensates.

While both of these considerations appear to have been beyond the psychiatrist's control, it is difficult to say the same of the alleged failure to make a specific referral or to educate the patient as to the severity of his illness. It is unclear how far a mental health professional must go in referring and educating a patient to avoid liability in such cases, but the jury clearly believed Liptzin didn't go far enough. In any event, it seems likely that liability might have been avoided in this case if the psychiatrist had made himself available to the patient after his retirement or had arranged for a trusted colleague to do so.

'Judicial notebook' is an effort by the Courtwatch Committee of APA's Div. 9, the Society for the Psychological Study of Social Issues, to encourage involvement by psychologists in judicial decision-making.



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