NAMI North Carolina The Wendell Williamson Case A Statement by the Board of Directors

Position Statement

The Wendell Williamson Case: A Statement of the Board of Directors

Released October 1, 1998

NAMI North Carolina is a grassroots organization for support, education and advocacy for people with mental illnesses and their families.

We deplore the senseless and tragic deaths and injuries Wendell Williamson inflicted, but we must also deplore the substandard medical treatment he received for his serious mental illness. This was the essence of the jury decision, and the unhappy fact is that with a history of paranoid schizophrenia and violent behavior, Wendell Williamson was not receiving appropriate care.

The jury heard from expert witnesses that schizophrenia is a serious brain disorder that can be treated effectively and that it is a waxing and waning lifelong chronic illness which impairs a person’s judgment, thinking and ability to relate to others. Our hearts go out to the families of the two men who lost their lives. The void left by this loss can never be filled. Our hearts go out to those injured and their families, for the pain and suffering they have endured.

Wendell Williamson’s personal tragedy of untreated brain disease led him, a former Eagle Scout, school leader and law student, to commit a heinous crime for which he is now being punished by indefinite incarceration and deprivation of personal liberty at Broughton Hospital. Our hearts go out to him and his family.

We call on citizens to reflect that the jury, unlike the public, has heard the entire story. The jury concluded the weight of the evidence showed Dr. Myron Liptzin was negligent and that his negligence was a proximate cause of damage to Mr. Williamson. In particular, the jury found Dr. Liptzin failed to take ordinary care in the transfer of his seriously ill patient to another psychiatrist when Dr. Liptzin retired.

We ask the public to respect the judicial process that led to the jury’s verdict. The case went through several screening steps before it came to trial, including a judicial determination of merit. Over a period of a week, the jurors heard evidence from the plaintiff, the defendant, and expert witnesses. They were thoroughly instructed by the judge and deliberated two days before reaching their unanimous decision.

NAMI North Carolina urges psychiatrists to avoid rushing to judgement with regard to this jury’s decision. We are particularly concerned by news reports and letters by spokespersons and academic leaders in psychiatry suggesting the possibility that clinicians may withhold treatment from seriously mentally ill patients because of this decision. We urge that this jury’s decision about one clinician’s negligence will not result in punitive action directed at patients. Rather, we hope it will result in greater vigilance in referral and monitoring follow up care of seriously ill patients.

This case can sound the alarm that our mental health system desperately needs attention. NAMI North Carolina urges that the potential for violent behavior by those with untreated serious mental illness be recognized, taken seriously, discussed in public forums with the goal of effecting changes in policy and practice. This is a major public health issue—to adequately treat an illness so that the general population is kept safe, If Wendell Williamson had received adequate care for the brain disease that took away his good judgment, this terrible tragedy might have been averted.

The Trial

It has been suggested that misplaced sympathy or confusion about the facts motivated the jury’s decision. Rather, the jury, unlike the public, heard the whole story and made their unanimous decision based on that full knowledge.

The jury heard testimony that instead of reviewing the complete medical record of Mr. Williamson’s 1992 hospitalization at UNC Hospital, Dr. Myron Liptzin chose to rely solely on the discharge summary of that hospitalization. The complete record included a psychological evaluation that literally forecast what was likely to happen should he not receive continuing care for his paranoid schizophrenia. The record also revealed Mr. Williamson had a history of violent behavior including self-injury and attempted suicide. The hospital discharged him on the condition that he continue outpatient treatment.

The jury heard testimony that Dr. Liptzin failed to clearly inform his patient that he had a serious, chronic mental illness called paranoid schizophrenia that required medication and counseling on a long-term basis. The doctor’s working diagnosis, “delusional disorder—grandiose,” remained as his diagnosis during his entire period of treating Mr. Williamson. Dr. Liptzin testified he did not wish to label his patient as a “paranoid schizophrenic.” An individual diagnosed with any other serious medical disorder, such as diabetes, heart disease or Alzheimer’s Disease, would have been informed of the true nature of the disorder and the need for continuing treatment.

The jury heard an expert witness state that the business of UNC’s Student Health Service is short-term treatment and referral, but Dr. Liptzin failed to refer his patient for follow-up care. After Mr. Williamson completed the six visits allowed for psychiatric care, Dr. Liptzin did not make a referral, either by telephone or letter. He did not refer Mr. Williamson to another clinician in the Student Health Service or at UNC Hospitals, or to a physician in Mr. Williamson’s home community. Dr. Liptzin, after his formal retirement, returned to the Student Health Service on a temporary basis for the following fall and spring semesters. During that time he made no attempt to ascertain whether Williamson was receiving any follow-up care. On cross-examination Dr. Liptzin said that there was no need to do so—that Williamson was responsible for that decision. The jury concluded Dr. Liptzin failed to meet the standard of care to ensure that his seriously ill patient received follow-up care after the doctor retired.

The jury heard that the standard of care requires a psychiatrist to use ordinary care in performing clinical tasks, such as conducting a thorough diagnostic evaluation with review of a patient’s medical record, reviewing and updating diagnoses, properly managing medications and making appropriate referrals.

The jury decided unanimously that the greater weight of the evidence showed Dr. Liptzin was negligent in failing to take ordinary care to prevent his seriously ill patient from the foreseeable deterioration that would be likely to occur, should he fail to continue taking his medication and receiving psychiatric counseling. The jury’s financial award to Mr. Williamson was based on Dr. Liptzin’s negligence.

Call To Action

We hope this case will be a call to action to North Carolina citizens, causing them to realize our mental health system needs priority attention. The study examining the state hospitals has been completed, and many of its recommendations endorsed by key legislators. Currently there is discussion about a new study which would extend the scope of the present hospital evaluation to area programs, their structure and function, When both studies and their recommendations are completed, perhaps a comprehensive state system of care will then become a reality.

Recent research from the Schizophrenia Patient Outcomes Research Team (PORT) survey reveals that the overall quality of care for persons with schizophrenia in our country is inadequate. Researchers examined the current patterns of usual care for persons with schizophrenia compared those patterns with 12 treatment recommendations. The investigators found the actual patients’ treatment conformed to recommendations only about half the time. The authors concluded, “current usual treatment practices likely fall substantially short of what would be recommended based on the best evidence of treatment efficacy.” NAMI North Carolina finds this disparity between what should be and what is alarming and desperately in need of action. (Lehman, Steinwachs, et al, 1998, p. 11.)

Scientific understanding of the mechanisms and treatment of brain disorders, including schizophrenia, has advanced significantly in the past decade. We know treatment works. Yet implementing the new information and new medications has lagged far behind advances in treatment for other major medical disorders, This is particularly true of aftercare or rehabilitation. Persons recovering from a stroke or a heart attack typically have a wide array of community-based rehabilitation services available, while those with paranoid schizophrenia have little access to aftercare in most communities.

While the untreated paranoid schizophrenia of Wendell Williamson resulted in senseless, preventable violence, the larger societal tragedy is that similar preventable events continue to occur in our country. We believe it will be impossible to decrease the stigma, fear and misunderstanding associated with crimes committed by persons with serious mental illness until the association of violent behavior and serious mental illness is better understood, addressed in policy and, ultimately, prevented.

Due to their illness, certain individuals with biological brain disorders, such as schizophrenia and manic-depressive illness, at times lack insight or judgment about their need for medical treatment. NAMI is also aware that laws and policies governing involuntary commitment, outpatient commitment and/or court-ordered treatment are little understood and unevenly applied.

Knowing what to do is easy. We have the knowledge. But finding the will and the dollars is more difficult. To fill the full spectrum of services needed by persons with disabling brain disorders, four critical elements must be in place:

• Community-based care including ongoing medical treatment, housing, rehabilitation and other support for those able to recognize their need for care and manage their own illness.
• Assertive community treatment programs that provide 24-hour-a-day outreach and crisis support for those less able to maintain their own treatment requirements.
• Outpatient treatment orders that require participation in treatment as a condition for living in the community for those who do not respond to outreach and resist treatment.
• Involuntary inpatient commitment that provides short-term hospitalization to treat and stabilize acute psychiatric symptoms for those whose symptoms make them unable to recognize their need for treatment.