{ "id": 9439355, "name": "WENDELL JUSTIN WILLIAMSON, Plaintiff v. MYRON B. LIPTZIN, M.D., Defendant", "name_abbreviation": "Williamson v. Liptzin", "decision_date": "2000-12-19", "docket_number": "No. COA99-813", "first_page": "1", "last_page": "19", "citations": [ { "type": "official", "cite": "141 N.C. App. 1" } ], "court": { "name_abbreviation": "N.C. Ct. App.", "id": 14983, "name": "North Carolina Court of Appeals" }, "jurisdiction": { "id": 5, "name_long": "North Carolina", "name": "N.C." }, "cites_to": [ { "cite": "495 S.E.2d 362", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1998, "pin_cites": [ { "page": "366", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "347 N.C. 541", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 551291 ], "year": 1998, "pin_cites": [ { "page": "546", "parenthetical": "citation omitted" } ], "opinion_index": 0, "case_paths": [ "/nc/347/0541-01" ] }, { "cite": "241 N.Y.S.2d 495", "category": "reporters:state", "reporter": "N.Y.S.2d", "year": 1963, "pin_cites": [ { "page": "496-97" } ], "opinion_index": 0 }, { "cite": "551 P.2d 334", "category": "reporters:state_regional", "reporter": "P.2d", "year": 1976, "pin_cites": [ { "page": "345", "parenthetical": "\"We recognize the difficulty that a therapist encounters in attempting to forecast whether a patient presents a serious danger of violence.\"" } ], "opinion_index": 0 }, { "cite": "511 F.2d 407", "category": "reporters:federal", "reporter": "F.2d", "case_ids": [ 153102, 3689455 ], "year": 1975, "pin_cites": [ { "page": "415", "parenthetical": "\"A claim of negligence must be considered in light of the elusive qualities of mental disorders and the difficulty of analyzing and evaluating them.\"" } ], "opinion_index": 0, "case_paths": [ "/f2d/511/0407-01", "/us-app-dc/167/0169-01" ] }, { "cite": "631 P.2d 173", "category": "reporters:state_regional", "reporter": "P.2d", "weight": 2, "year": 1981, "pin_cites": [ { "page": "176-77", "parenthetical": "footnote omitted" }, { "page": "176" } ], "opinion_index": 0 }, { "cite": "925 P.2d 324", "category": "reporters:state_regional", "reporter": "P.2d", "case_ids": [ 12259228 ], "year": 1996, "pin_cites": [ { "page": "338", "parenthetical": "quoting Seibel v. Kemble, 631 P.2d 173, 176-77 (Haw. 1981) (footnote omitted)" } ], "opinion_index": 0, "case_paths": [ "/haw/83/0154-01" ] }, { "cite": "399 N.E.2d 106", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1978, "pin_cites": [ { "page": "110" } ], "opinion_index": 0 }, { "cite": "326 S.E.2d 365", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1985, "pin_cites": [ { "page": "371" } ], "opinion_index": 0 }, { "cite": "73 N.C. App. 336", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8523965 ], "weight": 2, "year": 1985, "pin_cites": [ { "page": "344-45" } ], "opinion_index": 0, "case_paths": [ "/nc-app/73/0336-01" ] }, { "cite": "242 S.E.2d 538", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 1978, "pin_cites": [ { "page": "540" } ], "opinion_index": 0 }, { "cite": "35 N.C. App. 755", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8552252 ], "year": 1978, "opinion_index": 0, "case_paths": [ "/nc-app/35/0755-01" ] }, { "cite": "411 S.E.2d 651", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 4, "year": 1992, "pin_cites": [ { "page": "653" }, { "page": "653-54" }, { "page": "654", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "105 N.C. App. 64", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8521196 ], "weight": 2, "year": 1992, "pin_cites": [ { "page": "68" } ], "opinion_index": 0, "case_paths": [ "/nc-app/105/0064-01" ] }, { "cite": "290 S.E.2d 790", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 1982, "pin_cites": [ { "page": "791", "parenthetical": "citation omitted" }, { "page": "791" } ], "opinion_index": 0 }, { "cite": "57 N.C. App. 57", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8521910 ], "weight": 2, "year": 1982, "pin_cites": [ { "page": "59" } ], "opinion_index": 0, "case_paths": [ "/nc-app/57/0057-01" ] }, { "cite": "176 S.E.2d 161", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 1970, "pin_cites": [ { "page": "169", "parenthetical": "quoting William L. Prosser, Law of Torts \u00a7 50, at 303 (3d ed. 1964)" }, { "parenthetical": "\"Many of the [North Carolina proximate cause] cases could have been decided differently.\"" }, { "page": "169" } ], "opinion_index": 0 }, { "cite": "277 N.C. 94", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8561932 ], "weight": 3, "year": 1970, "pin_cites": [ { "page": "108", "parenthetical": "quoting William L. Prosser, Law of Torts \u00a7 50, at 303 (3d ed. 1964)" }, { "parenthetical": "\"Many of the [North Carolina proximate cause] cases could have been decided differently.\"" }, { "page": "108" } ], "opinion_index": 0, "case_paths": [ "/nc/277/0094-01" ] }, { "cite": "157 S.E.2d 719", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1967, "pin_cites": [ { "page": "723", "parenthetical": "citation omitted" }, { "page": "723", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "272 N.C. 24", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8570212 ], "weight": 2, "year": 1967, "pin_cites": [ { "page": "30", "parenthetical": "citation omitted" }, { "page": "30" } ], "opinion_index": 0, "case_paths": [ "/nc/272/0024-01" ] }, { "cite": "162 N.E. 99", "category": "reporters:state_regional", "reporter": "N.E.", "weight": 2, "year": 1928, "pin_cites": [ { "page": "103", "parenthetical": "Andrews, J., dissenting" }, { "page": "103", "parenthetical": "Andrews, J., dissenting" } ], "opinion_index": 0 }, { "cite": "78 S.E.2d 170", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1953, "pin_cites": [ { "page": "170", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "238 N.C. 448", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8611311 ], "year": 1953, "pin_cites": [ { "page": "449", "parenthetical": "citation omitted" } ], "opinion_index": 0, "case_paths": [ "/nc/238/0448-01" ] }, { "cite": "311 S.E.2d 559", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 11, "year": 1984, "pin_cites": [ { "page": "565", "parenthetical": "citations omitted" }, { "page": "565" }, { "page": "565", "parenthetical": "emphasis added" }, { "page": "565", "parenthetical": "citations omitted" }, { "page": "566" }, { "page": "565", "parenthetical": "citations omitted" }, { "page": "567" }, { "page": "566" } ], "opinion_index": 0 }, { "cite": "310 N.C. 227", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 2402972 ], "weight": 6, "year": 1984, "pin_cites": [ { "page": "233", "parenthetical": "citations omitted" }, { "page": "233-34" }, { "page": "234" }, { "page": "234" }, { "page": "235" } ], "opinion_index": 0, "case_paths": [ "/nc/310/0227-01" ] }, { "cite": "324 S.E.2d 294", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1985, "pin_cites": [ { "page": "298", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "72 N.C. App. 306", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8526633 ], "year": 1985, "pin_cites": [ { "page": "311", "parenthetical": "citation omitted" } ], "opinion_index": 0, "case_paths": [ "/nc-app/72/0306-01" ] }, { "cite": "364 S.E.2d 159", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1988, "pin_cites": [ { "page": "162", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "88 N.C. App. 539", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8358566 ], "year": 1988, "pin_cites": [ { "page": "543", "parenthetical": "citation omitted" } ], "opinion_index": 0, "case_paths": [ "/nc-app/88/0539-01" ] }, { "cite": "530 S.E.2d 838", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2000, "pin_cites": [ { "page": "843", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "138 N.C. App. 19", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 11078414 ], "year": 2000, "pin_cites": [ { "page": "26", "parenthetical": "citation omitted" } ], "opinion_index": 0, "case_paths": [ "/nc-app/138/0019-01" ] }, { "cite": "445 S.E.2d 29", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1994, "opinion_index": 0 }, { "cite": "336 N.C. 71", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 2534314, 2537066, 2536085, 2534232, 2536670 ], "year": 1994, "opinion_index": 0, "case_paths": [ "/nc/336/0071-01", "/nc/336/0071-04", "/nc/336/0071-05", "/nc/336/0071-03", "/nc/336/0071-02" ] }, { "cite": "437 S.E.2d 519", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1993, "pin_cites": [ { "page": "522", "parenthetical": "citation omitted" } ], "opinion_index": 0 }, { "cite": "113 N.C. App. 1", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8520443 ], "year": 1993, "pin_cites": [ { "page": "6", "parenthetical": "citation omitted" } ], "opinion_index": 0, "case_paths": [ "/nc-app/113/0001-01" ] } ], "analysis": { "cardinality": 1599, "char_count": 45208, "ocr_confidence": 0.759, "pagerank": { "raw": 5.064504149862598e-07, "percentile": 0.9374950045350134 }, "sha256": "938d40e33c2e1c639eba689fdbd464513f3c0eb49c0cd8fd810185534816ef86", "simhash": "1:472d3d82eee13c9c", "word_count": 7121 }, "last_updated": "2023-07-14T21:28:13.659098+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "Chief Judge EAGLES and Judge HUNTER concur." ], "parties": [ "WENDELL JUSTIN WILLIAMSON, Plaintiff v. MYRON B. LIPTZIN, M.D., Defendant" ], "opinions": [ { "text": "TIMMONS-GOODSON, Judge.\nThis case arises out of the tragic events of 26 January 1995, when Wendell Williamson (\u201cplaintiff\u2019) shot and killed two people in downtown Chapel Hill, North Carolina. Plaintiff brought suit against Myron B. Liptzin (\u201cdefendant\u201d), a psychiatrist at Student Psychological Services of the University of North Carolina at Chapel Hill (\u201cStudent Services\u201d) who treated plaintiff, on the grounds that he was damaged by the negligence of defendant.\nThe evidence presented at trial tended to show the following. Student Services operates only on a voluntary, outpatient basis. In May 1990, as an undergraduate student, plaintiff visited Student Services as a \u201cwalk-in,\u201d and received counseling for relationship issues and academic problems. The doctor who reviewed plaintiff\u2019s intake form concluded that plaintiff\u2019s problems were \u201cfairly normative.\u201d\nIn September 1992, when plaintiff was a twenty-four-year-old law student at the University of North Carolina at Chapel Hill (\u201cUNC\u201d), he screamed at students on campus and struck himself about the face. Plaintiff was referred to Student Services. As a result, Student Services further referred him to the UNC Hospitals, where he was involuntarily committed. During his stay, plaintiff disclosed that he had been hearing a voice talking to him for eight months and that he believed he was telepathic. The hospital staff recorded that plaintiff possessed a gun in his apartment.\nPlaintiff refused to voluntarily remain at the hospital and also refused medication. A court petition was filed to have plaintiff involuntarily committed. Following a commitment hearing, the presiding judge denied the petition and recommended that plaintiff seek outpatient psychiatric counseling. The final primary diagnosis was \u201crule/out schizophrenia.\u201d One of plaintiff\u2019s expert psychiatrists explained at trial that the term \u201crule/out schizophrenia\u201d means that either: (a) \u201cit\u2019s [schizophrenia] until proven otherwise, but we haven\u2019t had enough time to prove otherwise yet[,]\u201d or (b) \u201cyou should keep [schizophrenia] first and foremost in your mind until a less serious condition is shown to be causing the problem.\u201d\nOn 2 March 1994, plaintiff was again referred to Student Services after he disrupted class at the law school by announcing that he was a \u201ctelepath.\u201d Plaintiff completed an intake form on which he denied any urge \u201cto hit, injure or harm someone\u201d or any \u201c[s]uicidal thoughts or concerns.\u201d Intake psychologists assessed that involuntary hospitalization was \u201cnot appropriate as student denies danger to self or others.\u201d Plaintiff was again diagnosed with \u201crule/o[ut] schizophrenia.\u201d The staff recommended treatment and medication, which plaintiff refused. However, after a law school dean informed plaintiff that he might not be recommended as a candidate for the bar exam unless he received counseling, plaintiff agreed to seek treatment.\nDuring a ten-week period beginning on 8 March 1994, plaintiff had six counseling sessions with defendant at Student Services, each of which lasted between twenty minutes and one hour. Defendant prepared for the treatment by reviewing plaintiffs chart from Student Services, which included an intake form from plaintiffs May 1990 visit to Student Services and a \u201cdischarge summary\u201d from his 1992 hospital stay. However, defendant did not review the complete medical records from plaintiffs 1992 treatment. During the first session with defendant, plaintiff stated that he had believed he was a \u201ctelepath\u201d for two years, he consumed approximately six beers each night, and he used marijuana occasionally. Defendant suggested that plaintiff begin taking an antipsychotic drug, Navane, and diagnosed plaintiff with \u201cdelusional disorder grandiose.\u201d While defendant recognized that plaintiff exhibited some symptoms of schizophrenia, he decided to record the more \u201cgenerous\u201d diagnosis, so as not to deprive plaintiff of the opportunity to practice law.\nOn 5 April 1994, during the fourth counseling session, defendant informed plaintiff that defendant would be leaving Student Services in June, and suggested that plaintiff \u201cconsider the possibility of seeing somebody on a regular basis in therapy, and that [defendant] would be happy to make a referral for him; that it would probably make sense to do this sooner rather than later.\u201d\nThe last counseling session between plaintiff and defendant occurred on 25 May 1994. Plaintiff informed defendant that he was not sure whether he would stay in Chapel Hill for the summer or whether he would stay with his family in Clyde, North Carolina. Defendant recorded in plaintiffs medical chart that plaintiff knew defendant would be leaving Student Services and that plaintiff would be seeing his replacement in the fall semester. Defendant told plaintiff that he needed to contact defendant\u2019s replacement so that he could have his prescriptions filled.\nDuring plaintiffs final counseling session, defendant supplied plaintiff with a prescription for thirty Navane capsules. Defendant recorded that plaintiff was \u201ccontent to stay on [Navane].\u201d As plaintiff\u2019s plans for the summer were uncertain, defendant instructed plaintiff that if he returned to Clyde, he was to visit the community health center or see his family doctor. If, on the other hand, plaintiff remained in Chapel Hill, he was to return to Student Services for counseling with defendant\u2019s replacement.\nDuring the course of his treatment, plaintiff followed virtually all of defendant\u2019s instructions concerning the regularity with which he was to take his medication. Plaintiff testified that he did on one occasion \u201cvoluntarily [go] off his medication,\u201d but reported it to defendant. Plaintiff reported that he was no longer hearing voices, his \u201ctelepathy\u201d and delusions were completely gone, and his hallucinations were either completely gone or virtually gone. Although he still used alcohol and recreational drugs, his usage had decreased. Plaintiff attended all of his classes without incident, sat for his law school exams, improved his grades, and took part in a law school writing competition. Friends reported that plaintiff was \u201cmore \u2018like his old self.\u2019 \u201d While he was under defendant\u2019s care, plaintiff had no thoughts of harming or killing himself or anyone else. His first thoughts of harming others occurred \u201cmuch later\u201d or \u201csome number of months\u201d after he last saw defendant.\nPlaintiff believed that his mental illness was temporary and that the medication was a short-term measure. According to plaintiff, defendant told him \u201cthat in his opinion, [plaintiff] was probably not really schizophrenic or psychotic.\u201d Plaintiff further stated that defendant told him that \u201cif someday [he] wanted to go off the medication, that [he] could do that if [he] told someone [he] trust[ed].\u201d\nPlaintiff spent the summer at his parents\u2019 home in Clyde. He did not visit the community health center or Student Services. Plaintiff decided to stop taking Navane for a few days, as the drug made him susceptible to the sun and he had become sunburned. After he discontinued his medication, plaintiff felt physically better. He determined that he would stop taking his medication indefinitely and informed his parents of that decision.\nPlaintiff returned to Chapel Hill in August 1994 for the fall semester. He attended virtually all of his classes and did not disrupt any of them. He passed all of his courses, managed his finances, and took care of his day-to-day needs, such as grooming, eating, and shopping. He took trips alone in his car, including trips to Connecticut and New York City over Christmas break.\nIn January 1995, plaintiff returned to Chapel Hill and began living out of his car. He stopped attending classes and purchased guns and ammunition. In addition, plaintiff returned to Clyde to retrieve a M-l rifle, the gun UNC Hospital staff noted he possessed. This weapon had been in Clyde since plaintiffs hospital stay in 1992. On 26 January 1995, eight months after his last session with defendant, plaintiff randomly fired the M-l rifle at unarmed people in downtown Chapel Hill, killing two of them. In an effort to stop plaintiff, police officers shot him in the legs. Plaintiff required surgery for the leg wounds. Plaintiff was charged with two counts of first-degree murder. In November 1995, he was found not guilty by reason of insanity.\nPsychiatrist Stephen Kramer (\u201cDr. Kramer\u201d) testified as an expert witness on behalf of plaintiff. Dr. Kramer stated that defendant violated the standard of care for a psychiatrist with similar training and experience practicing in Chapel Hill, North Carolina, or similar communities, in 1994. Dr. Kramer specified that defendant failed \u201cto pursue a proper diagnosis, including review of old records available and assessing risk for potential deterioration and violence[,]\u201d failed \u201cto develop a program for continuing care [for plaintiff] once [defendant] retired and left the Student Health Center,\u201d failed to address the issue of noncompliance, and failed to properly manage the use of antipsy-chotic medication. Dr. Kramer noted that the discharge summary from plaintiffs hospital stay indicated that he had no insight into his illness and that he had a history of noncompliance. Dr. Kramer stated that especially' in this context, if defendant advised plaintiff that he could go off his medication if he told a responsible adult, such advice would have been improper and an \u201cinvitation to not comply with the recommended therapy.\u201d\nAccording to Dr. Kramer, the correct diagnosis was chronic paranoid schizophrenia rather than delusional disorder grandiose, and defendant\u2019s failure to review the medical records from plaintiffs inpatient stay at UNC Hospitals in 1992 contributed to the misdiagnosis. Dr. Kramer further noted that there was a marked difference between plaintiffs diagnosis of delusional disorder and schizophrenia. Dr. Kramer explained that schizophrenia is a long-term, lifelong illness requiring long-term care, while delusional disorder was more intermittent in nature.\nDr. Kramer testified that it was \u201charder to answer\u201d whether defendant could have reasonably foreseen that plaintiff would become violent to himself or others. Dr. Kramer further testified:\nFirst was, what\u2019s foreseeable is noncompliance with treatment, which would directly lead to exacerbation or increase in the psychotic symptoms, especially that of his thought processes. His insight and judgment would remain poor or get worse. He would continue abusing substances .... That access to a gun might not be cut off for him but might be reunited with him, and that dangerous behavior might occur.\nThose elements regarding dangerousness may come together at a point in time.\nWhen asked whether he was \u201cprepared to say ... a part of foreseeability would be dangerousness ... to himself or others[,]\u201d Dr. Kramer answered, \u201cI\u2019m not sure that I can go that far with it. I can say that the foreseeable elements are those that when they come together in time would lead to dangerousness.\u201d Had plaintiff received a proper diagnosis and treatment, his delusions and acting out could have been kept under control, according to Dr. Kramer.\nJames Bellard (\u201cDr. Bellard\u201d), a psychiatrist, also testified as an expert witness on behalf of plaintiff. Dr. Bellard agreed that defendant violated the applicable standard of care by misdiagnosing plaintiff and failing to ensure that plaintiff received ongoing care, especially given plaintiff\u2019s history of noncompliance. Dr. Bellard stated that it was foreseeable that plaintiff would again believe he was a \u201ctelepath.\u201d When asked where that would lead, Dr. Bellard answered, \u201cIf I may, that\u2019s not what\u2019s foreseeable. What\u2019s foreseeable is that he would believe [he was a \u201ctelepath\u201d] again. But what he would do with that, I don\u2019t think \u2014 nobody\u2019s crystal ball is that good, that they could predict that.\u201d Dr. Bellard further stated that if defendant had given plaintiff the name of a specific doctor to visit during the summer of 1994, Dr. Bellard still could not predict what would have happened. Dr. Bellard stated that \u201cit was foreseeable that [plaintiff] would deteriorate and eventually decompensate, that he would really fall apart mentally, eventually.\u201d Once he began to deteriorate, plaintiff would certainly become dangerous to himself, according to Dr. Bellard. Both Drs. Kramer and Bellard acknowledged that plaintiff improved under defendant\u2019s care and stated that plaintiff made no expressions of violence and was not committable at any point during his treatment.\nPsychologist John Warren, III (\u201cDr. Warren\u201d) testified on behalf of plaintiff as an expert witness in psychology and the treatment of paranoid schizophrenia. Dr. Warren stated that plaintiff was not competent to take charge of his medical treatment at the time his therapy with defendant ended. Dr. Warren testified that\nthere\u2019s nothing in the record that suggests that [plaintiff] got that information that he needed in order to make decisions about whether or not he had a major mental illness, whether or not he needed to take medication on a long-term basis, what he needed to do in case the symptoms got worse.\nPlaintiff reported to Dr. Warren on the day following the shootings that defendant had advised him that he could discontinue his medication if he told someone he trusted.\nConcerning schizophrenia, Dr. Warren echoed the testimony of Dr. Kramer stating that it was a very serious, major mental disorder, requiring lifelong treatment. Dr. Warren also testified that \u201c[a]s a group, people with schizophrenia, paranoid type, are among the most likely to hurt themselves or hurt other people.\u201d Dr. Warren believed that because plaintiff did not understand the seriousness of his illness, he could not make competent decisions concerning treatment.\nWhen asked whether it was foreseeable that defendant \u201cmight\u201d degenerate and become dangerous to himself or others, Dr. Warren responded by stating that plaintiff would become sicker, which \u201cmight\u201d result in violence to himself or others. Both Drs. Kramer and Warren testified that plaintiff exhibited risk factors for dangerous behavior such as being a young male, living alone, and having access to a gun.\nHolly Rogers (\u201cDr. Rogers\u201d), a psychiatrist at Duke University\u2019s Student Counseling Center, testified as an expert on behalf of defendant. Dr. Rogers indicated that student mental health centers provide \u201cshort-term treatment.\u201d Dr. Rogers stated that \u201c[m]ost psychotic people aren\u2019t dangerous.\u201d Similarly, Jeffrey Janofsky (\u201cDr. Janofsky\u201d), a psychiatrist at Johns Hopkins University, stated that \u201cbecause the base rate of violence is so low, and most schizophrenics aren\u2019t violent and most normal people aren\u2019t violent either, that demographic data does not get you anywhere in predicting dangerousness.\u201d\nBruce Berger (\u201cDr. Berger\u201d), a psychiatrist who previously worked as a student health counselor at East Carolina University, testified on behalf of defendant. He stated that in the student health setting, psychiatrists are only able to work with students for a short time \u201cbefore [the students] have to make plans with or without [the psychiatrists\u2019] assistance to get further treatment, or at least make choices in their life.\u201d\nPlaintiff filed suit against defendant on 16 May 1997, alleging that defendant had been negligent and that the negligence caused him to be shot in the legs, endure a murder trial, and be confined indefinitely to a mental institution. Defendant moved for summary judgment. On 4 September 1998, the trial court entered an order denying defendant\u2019s motion, concluding that \u201ca genuine issue of material facts exist[ed] to show that [defendant] breached the applicable standard of care and that [defendant\u2019s] treatment proximately caused injury to [plaintiff].\u201d The court further found that defendant failed to prove that there was no triable issue concerning contributory negligence.\nThe case was tried in the Superior Court, Orange County, before a jury. Defendant moved for directed verdict at the close of plaintiff\u2019s evidence and at the close of all the evidence. The trial court denied the motions and submitted the case to the jury, which determined that plaintiff was damaged by the negligence of defendant and that plaintiff was not contributorily negligent. Based on the jury verdict, the trial court entered judgment ordering defendant to pay $500,000 with interest and the court costs of the action to plaintiff. Defendant moved for a new trial or judgment notwithstanding the verdict. On 31 March 1999, the trial court entered an order denying the motions. Defendant appeals.\nDefendant argues that the trial court erred in denying his dispos-itive motions. Defendant first contends that the trial court erred in denying his motions for directed verdict and for judgment notwithstanding the verdict (\u201cJNOV\u201d). See N.C. Gen. Stat. \u00a7 1A-1, Rule 50 (1999). A motion for JNOV is a renewal of a motion for directed verdict made after the jury has returned its verdict. As such, a JNOV \u201cshall be granted if it appears that the motion for directed verdict could properly have been granted.\u201d N.C.G.S. \u00a7 1A-1, Rule 50(b)(1).\nIn deciding whether to grant or deny either motion, the trial court must accept the non-movant\u2019s evidence as true and view all the evidence \u201cin the light most favorable to [him], giving [him] the benefit of every reasonable inference which may be legitimately drawn therefrom, with conflicts, contradictions, and inconsistencies being resolved in the [non-movant\u2019s] favor.\u201d Bryant v. Thalhimer Brothers, Inc., 113 N.C. App. 1, 6, 437 S.E.2d 519, 522 (1993) (citation omitted), dismissal allowed and disc, review denied, 336 N.C. 71, 445 S.E.2d 29 (1994). \u201cIf there is more than a scintilla of evidence supporting each element of the non-movant\u2019s claim, the motion should be denied.\u201d Poor v. Hill, 138 N.C. App. 19, 26, 530 S.E.2d 838, 843 (2000) (citation omitted). An appellate court\u2019s review of a denial of these motions is limited to a consideration of \u201cwhether the evidence viewed in the light most favorable to [the non-movant] is sufficient to support the jury verdict.\u201d Suggs v. Norris, 88 N.C. App. 539, 543, 364 S.E.2d 159, 162 (1988) (citation omitted).\nTo prevail on a claim of negligence, the plaintiff must establish that the defendant owed him a duty of reasonable care, \u201cthat [the defendant] was negligent in his care of [the plaintiff,] and that such negligence was the proximate cause of [the plaintiff\u2019s] injuries and damage.\u201d Beaver v. Hancock, 72 N.C. App. 306, 311, 324 S.E.2d 294, 298 (1985) (citation omitted). While we recognize that this case presents a variety of novel issues concerning virtually every facet of negligence, we have chosen to focus our discussion on the element of proximate cause. Defendant\u2019s main contention on appeal is, in fact, that his alleged negligence was not the proximate cause of plaintiff\u2019s injuries, and therefore he was entitled to a directed verdict and JNOV. With this, we must agree.\nNorth Carolina appellate courts define proximate cause as\na cause which in natural and continuous sequence, unbroken by any new and independent cause, produced the plaintiff\u2019s injuries, and without which the injuries would not have occurred, and one from which a person of ordinary prudence could have reasonably foreseen that such a result, or consequences of a generally injurious nature, was probable under all the facts as they existed.\nHairston v. Alexander Tank & Equipment Co., 310 N.C. 227, 233, 311 S.E.2d 559, 565 (1984) (citations omitted). The element of foreseeability is a requisite of proximate cause. Id. To prove that an action is foreseeable, a plaintiff is required to prove that \u201cin \u2018the exercise of reasonable care, the defendant might have foreseen that some injury would result from his act or omission, or that consequences of a generally injurious nature might have been expected.\u2019 \u201d Hart v. Curry, 238 N.C. 448, 449, 78 S.E.2d 170, 170 (1953) (citation omitted). Thus, the plaintiff does not have to prove that the defendant foresaw the injury in its precise form. Hairston, 310 N.C. at 233-34, 311 S.E.2d at 565; see also Palsgraf v. Long Island R. Co., 162 N.E. 99, 103 (1928) (Andrews, J., dissenting) (\u201cIt does not matter that [the actual injuries] are unusual, unexpected, unforeseen, and unforeseeable.\u201d) However, the law does not require that the defendant \u201cforesee events which are merely 'possible but only those which are reasonably foreseeable.\u201d Hairston, 310 N.C. at 234, 311 S.E.2d at 565 (emphasis added) (citations omitted).\nA man\u2019s responsibility for his negligence must end somewhere. If the connection between negligence and the injury appears unnatural, unreasonable and improbable in the light of common experience, the negligence, if deemed a cause of the injury at all, is to be considered remote rather than a proximate cause. It imposes too heavy a responsibility for negligence to hold the [tort-feasor] responsible for what is unusual and unlikely to happen or for what was only remotely and slightly possible.\nPhelps v. Winston-Salem, 272 N.C. 24, 30, 157 S.E.2d 719, 723 (1967) (citation omitted); accord Sutton v. Duke, 277 N.C. 94, 108, 176 S.E.2d 161, 169 (1970) (quoting William L. Prosser, Law of Torts \u00a7 50, at 303 (3d ed. 1964)) (\u201cit is \u2018inconceivable that any defendant should be held liable to infinity for all the consequences which flow from his act,\u2019 [thus] some boundary must be set\u201d).\nForeseeability is but one element of proximate cause. Wyatt v. Gilmore, 57 N.C. App. 57, 290 S.E.2d 790 (1982). Other \u201cequally important considerations\u201d include:\nwhether the cause is, in the usual judgment of mankind, likely to produce the result; whether the relationship between cause and effect is too attenuated; whether there is a direct connection without intervening causes; whether the cause was a substantial factor in bringing about the result; and whether there was a natural and continuous sequence between the cause and the result.\nId. at 59, 290 S.E.2d at 791 (citation omitted).\nPlaintiff alleged that he was injured as a result of defendant\u2019s actions, in that he was wounded during the 26 January 1995 shootout, tried for capital murder, and confined to a mental institution. An examination of the evidence, construed in the light most favorable to the plaintiff, reveals that defendant could not foresee plaintiff\u2019s injuries. There was absolutely no evidence that plaintiff posed a threat of violence to others which would in turn lead to injury. When asked whether dangerousness to others or to plaintiff himself was foreseeable, plaintiff\u2019s own expert, Dr. Kramer stated, \u201cI\u2019m not sure that I can go that far with it.\u201d Another one of plaintiffs experts. Dr. Bellard, likewise testified that it was not foreseeable that plaintiff would kill others. In fact, in the most telling testimony at trial, Dr. Bellard further responded, \u201c[NJobody\u2019s crystal ball is that good[.]\u201d\nPlaintiffs own behavior prior to or at the time of defendant\u2019s retirement in no way indicated that he would become violent. Other than striking himself about the face, plaintiff never exhibited violent behavior. On his 2 March 1994 intake form, plaintiff noted that he had no urge to harm others and that he had no suicidal thoughts.\nPlaintiff even noticed an improvement in his condition. Plaintiff informed defendant that he no longer heard voices and his hallucinations were virtually gone. Plaintiff further noted that he had decreased his use of alcohol and recreational drugs, had attended his law school classes without incident, and had improved his grades. Furthermore, although plaintiff testified that he contemplated suicide in 1992, he admitted that he never seriously thought of harming himself between the 1992 hospitalization and 1994, including the period in which he saw defendant. Plaintiff further affirmed that thoughts of harming others only occurred \u201csome number of months\u201d after his last visit with defendant. In his notes from the last visit with plaintiff, defendant wrote that plaintiff stated \u201chis friends have been giving him feedback that he\u2019s more \u2018like his old self, and the guy they used to know and like.\u2019 \u201d\nIn addition to being unforeseeable, plaintiff\u2019s injuries were too remote in time, and the chain of events which lead to plaintiff\u2019s injuries was too attenuated for defendant\u2019s actions to be the proximate cause of plaintiffs injuries. It was eight months between plaintiffs last visit with defendant and the incident which led to his injuries. Plaintiff was, by all accounts, functioning normally when he last visited defendant in May 1994. Plaintiff spent the summer with his parents in Clyde, at which time he discontinued his medication and failed to visit a mental health center or to have his prescriptions refilled. In August 1994, plaintiff returned to law school and began his fall classes. Plaintiff testified that his hallucinations began to resurface gradually and achieved fruition sometime in August or September. However, plaintiff attended virtually all of his classes during the fall semester, without disruption, and passed every course. He maintained his daily needs, including eating, grooming, shopping, and managing his financial affairs. Furthermore, after completing the semester, plaintiff took two long trips alone, after which time he returned to his parents\u2019 home in Clyde.\nIn January 1995, plaintiff returned to Chapel Hill. Only at this time did plaintiff begin living out of his car, stop attending classes, and purchase guns and ammunition. Eight months after his last visit with defendant, plaintiff shot and killed two individuals in Chapel Hill, despite never expressing any intent to do so. Defendant simply could not have foreseen that as a result of this attenuated chain of events, eight months after his last appointment, plaintiff, who expressed no violent intentions or threats, would be wounded during a shoot-out, tried for capital murder, committed to a mental institution, and not able to continue his legal studies or pursue a possible career.\nDespite this attenuated chain of events, plaintiff contends that the testimony of his experts was tantamount to the issue of foreseeability and was more than sufficient to establish that \u201csome\u201d injury was foreseeable. With this argument, we cannot agree.\nIn his testimony, Dr. Kramer expressed difficulty in concluding that plaintiffs dangerousness to others was foreseeable. Dr. Kramer then testified as follows:\n[Wjhat\u2019s foreseeable is noncompliance with treatment, which would directly lead to exacerbation or increase in the psychotic symptoms, especially that of his thought processes. His insight and judgment would remain poor or get worse. He would continue abusing substances .... That access to a gun might not be cut off for him but might be reunited with him, and that dangerous behavior might occur.\nThose elements regarding dangerousness may come together at a point in time. (Emphasis added.)\nDr. Kramer later testified that although he could not go so far as to say that plaintiffs dangerousness was foreseeable, \u201c[he could] say that the foreseeable elements are those that when they come together in time would lead to dangerousness.\u201d\nDr. Bellard testified that it was foreseeable that plaintiff would again believe he was a \u201ctelepath\u201d and \u201cit was foreseeable that [plaintiff] would deteriorate and eventually decompensate, that he would really fall apart mentally, eventually.\u201d Dr. Bellard further testified that no one could predict \u201cwhat [plaintiff] would do with that.\u201d Dr. Bellard stated that certain \u201crisk factors\u201d such as plaintiffs \u201cself-injurious behavior, a history of psychosis, a history of being resistant to treatment, and an ongoing history of substance abuse,\u201d would place plaintiff at a \u201c [considerably greater risk\u201d for violence against himself. Dr. Bellard could not definitively say that being at risk for violence to oneself was a \u201crisk factor\u201d for violence to others. Both Drs. Kramer and Warren stated that plaintiff\u2019s age, gender, his living alone, and his owning a gun were \u201crisk factors\u201d for violence.\nThe experts\u2019 testimony does not establish foreseeability but evinces a situation similar to those in which our appellate courts hesitate to find an individual liable for a possible breach of duty. In Westbrook v. Cobb, 105 N.C. App. 64, 411 S.E.2d 651 (1992), for example, the defendant\u2019s vehicle struck a utility pole connected to a transformer, which serviced the plaintiff\u2019s house. As a result, the plaintiff\u2019s house caught on fire. The plaintiff, who was one and one-half miles from his house, was alerted to the fire and arrived on the scene to assist firefighters in controlling the blaze. The plaintiff went into his house to retrieve some items, and in the process, injured his back. This Court found that \u201cthe chain of events resulting in [the plaintiff\u2019s] injury [was not] reasonably foreseeable and within the contemplation of an ordinary prudent individual.\u201d Id. at 68, 411 S.E.2d at 653. Thus, the Court found that proximate cause did not exist. Id. at 68-69, 411 S.E.2d at 653-54.\nIn Coltrane v. Hospital, 35 N.C. App. 755, 242 S.E.2d 538 (1978), the Administratrix of the estate of a deceased patient brought an action against a hospital for the death of the patient, who fell from a second story ledge. The patient had been placed in restraints to prevent him from falling out of his bed. The patient wrestled free from the restraints and was seen standing on the second story ledge. The patient was later found dead. Our Court concluded that any negligence which could be imputed to the hospital was not the proximate cause of the patient\u2019s death because \u201cthere [was] no evidence that defendant hospital could have foreseen the fall from the ledge of the second floor.\u201d Id. at 758, 242 S.E.2d at 540. In so concluding, this Court relied on the testimony of the patient\u2019s doctor, who stated that the restraints were only to keep the patient from falling out of the bed and that he did not view the patient as suicidal. Id.\nAlthough not completely analogous to the case at bar, these cases illustrate that North Carolina courts are reluctant to hold a person liable where the chain of events which led to the resulting injuries is unforeseeable, remote, and attenuated, even though \u201csome\u201d injury to plaintiff was \u201cpossible.\u201d See Hairston, 310 N.C. at 234, 311 S.E.2d at 565 (citations omitted). The contemplation of what \u201cmight\u201d happen, which leads to what \u201cmight\u201d or \u201cmay\u201d potentially be the outcome, and the consideration of \u201crisk factors\u201d for violence to oneself which may or may not lead to a risk of violence to others, is simply not sufficient as a matter of law to establish the foreseeability of plaintiffs injuries or the circumstances in which the alleged injuries arose. Furthermore, evidence of \u201crisk factors\u201d for potential violence, such as gun ownership, being under a certain age, or being of a certain gender, implicates a large portion of our population and is simply insufficient in and of itself to prove foreseeability. Given the lack of evidence of violence or any threats of violence on plaintiff\u2019s behalf, \u201cthe connection between negligence and the injury appears unnatural, unreasonable, and improbable.\u201d Phelps, 272 N.C. at 30, 157 S.E.2d at 723 (citation omitted). We therefore conclude that the expert testimony presented by plaintiff established what was merely possible and not what was reasonably foreseeable.\nPlaintiff also argues that evidence of foreseeability in the instant case far surpasses the evidence presented in Hairston, 310 N.C. 227, 311 S.E.2d 559, and in other cases in which our appellate courts have deemed proximate cause an issue for the jury. Plaintiff contends that like the defendant in Hairston, defendant in the case sub judice should have foreseen an injury would result from his actions. We find Hairston distinguishable from the present case.\nIn Hairston, our Supreme Court examined the liability of a car dealership in a wrongful death suit by a deceased motorist\u2019s wife against the dealer and a truck driver. On the same day as the accident which led to the suit, the motorist purchased an automobile from defendant dealer. While the motorist waited, the dealer changed the tires on the vehicle, but failed to tighten the lug nuts on one of the wheels. The motorist drove the car out of the dealer\u2019s lot and within minutes, the loose wheel fell off. The motorist stopped the car, and a van pulled up behind the disabled vehicle. As the motorist stood between his car and the van, the defendant truck driver struck the van, killing the motorist.\nOur Supreme Court held that proximate cause existed to hold the dealer liable for the motorist\u2019s death. Id. at 235, 311 S.E.2d at 566. The court found that the dealer could have foreseen the accident which led to plaintiff\u2019s injuries. Id. The Court noted that defendant dealer was on \u201cnotice of the exigencies of traffic, and he must take into account the prevalence of the \u2018occasional negligence which is one of the incidents of human life.\u2019 \u201d Id. at 234, 311 S.E.2d at 565 (citations omitted).\nIn the case at bar, plaintiff\u2019s violent rampage occurred eight months after his final session with defendant, while the time between the dealer\u2019s negligence and the motorist\u2019s harm in Hairston was \u201cbarely six minutes.\u201d Id. at 238, 311 S.E.2d at 567. More importantly, treating plaintiff\u2019s mental illness and predicting future human behavior are vastly different than maintaining an automobile and predicting traffic. Indeed, this Court as well as courts in other jurisdictions have previously recognized the difficulties inherent in the treatment and diagnosis of mental illness. In Pangburn v. Saad, 73 N.C. App. 336, 326 S.E.2d 365 (1985), this Court stated:\n\u201cThe uncertainties inherent in analyzing and treating the human mind, let alone the decision of when a person is \u2018cured\u2019 and no longer a danger, renders the decisions of skilled doctors highly discretionary and subject to rebuke only for the most flagrant, capricious, and arbitrary abuse.\u201d\n73 N.C. App. at 344-45, 326 S.E.2d at 371 (quoting Leverett v. State, 399 N.E.2d 106, 110 (Ohio Ct. App. 1978)); see also Lee v. Corregedore, 925 P.2d 324, 338 (Haw. 1996) (quoting Seibel v. Kemble, 631 P.2d 173, 176-77 (Haw. 1981) (footnote omitted)) (\u201c \u2018There is much uncertainty in the diagnosis and treatment of mental illness and in the prediction of future behavior.\u2019 \u201d); Hicks v. United States, 511 F.2d 407, 415 (D.C. Cir. 1975) (\u201cA claim of negligence must be considered in light of the elusive qualities of mental disorders and the difficulty of analyzing and evaluating them.\u201d); Tarasoff v. Regents of Univ. of California, 551 P.2d 334, 345 (Cal. 1976) (\u201cWe recognize the difficulty that a therapist encounters in attempting to forecast whether a patient presents a serious danger of violence.\u201d)\nThe uncertainties in diagnosing diseases of the human mind and predicting future behavior were further hampered in the instant case by the setting in which defendant observed plaintiff. Defendant treated plaintiff not in a hospital or private out-patient facility, but in an out-patient student health care facility. Dr. Rogers, a university student counseling center psychiatrist, testified that student health centers provide only \u201cshort-term treatment.\u201d Dr. Berger, a former counselor at a university facility, likewise testified that a psychiatrist in a student health care setting provides short-term care \u201cbefore [the student has] to make plans with or without [the psychiatrist\u2019s] assistance to get further treatment, or at least make choices in his life.\u201d There is no doubt that such a limited setting, coupled with the few number of times defendant observed plaintiff, impeded defendant\u2019s ability to predict and foresee plaintiffs actions eight months after their last meeting.\nOur conclusions concerning the foreseeability of plaintiffs injuries and the unpredictability of mental illness are further supported by public policy concerns. A court must \u201cevaluate [the plaintiffs] allegations in light of the goal of treatment, recovery and rehabilitation of those afflicted with a mental disease, defect or disorder.\u201d Seibel, 631 P.2d at 176. Imposing liability on a psychiatrist in an outpatient, short-term care setting for the actions of a patient that were at most based on risk factors and not foreseeability would have adverse effects on psychiatric care. It would encourage psychiatrists and other mental health providers to return to paternalistic practices, such as involuntary commitment, to protect themselves against possible medical malpractice liability. Despite public perceptions to the contrary, the vast majority of the mentally ill are not violent or are no more violent than the general population and thus, such rigid measures as involuntary commitment are rarely a necessity. See generally John Monahan, Mental Disorder and Violent Behavior: Perceptions and Evidence, 47 Am. Psychol. 511, 519 (1992) (\u201cNone of the data give any support to the sensationalized caricature of the mentally disordered served up by the media, the shunning of former patients by employers and neighbors in the community, or regressive \u2018lock \u2019em all up\u2019 laws [based on] public fears.\u201d); Linda A. Teplin, The Criminality of the Mentally III: A Dangerous Misconception, 142 Am. J. Psychiatry 593, 598 (1985) (\u201cstereotype[s] of the mentally ill as dangerous [are] not substantiated by our data\u201d). \u201cIf a liability were imposed on the physician . . . each time the prediction of future course of mental disease was wrong, few releases would ever be made and the hope of recovery and rehabilitation of a vast number of patients would be impeded and frustrated.\u201d Taig v. State, 241 N.Y.S.2d 495, 496-97 (N.Y. App. Div. 1963).\nIn the instant case, plaintiff functioned well under defendant\u2019s less-restrictive outpatient care, despite having what his experts termed a very serious mental illness. He passed all of his law school courses, took his medication on a regular basis, and even noted his friends\u2019 positive comments on his improved behavior. This improvement came without the need for involuntary commitment. In fact, plaintiff\u2019s own experts\u2019 testimony established that at the time he was being treated by defendant, plaintiff, like the majority of the mentally ill, was not a candidate for involuntary commitment.\nFurthermore, North Carolina\u2019s policy on the mentally ill promotes less restrictive methods of treatment and more patient autonomy.\nThe policy of the State is to assist individuals with mental illness, development disabilities, and substance abuse problems in ways consistent with the dignity, rights, and responsibilities of all North Carolina citizens. Within available resources, [the State is to provide] services to eliminate, reduce, or prevent the disabling effects of mental illness . . . through a service delivery system designed to meet the needs of clients in the least restrictive available setting, if the least restrictive setting is therapeutically most appropriate, and to maximize their quality of life.\nN.C. Gen. Stat. \u00a7 122C-2 (1999); see also Cobo v. Raba, 347 N.C. 541, 546, 495 S.E.2d 362, 366 (1998) (citation omitted) (\u201ca patient has an active responsibility for his own care and well-being\u201d). It would therefore be irrational to promote unnecessary, more restrictive practices in affirming the judgment below.\nWe recognize that our jurisprudence in the area of proximate cause is quite varied. See generally Sutton, 277 N.C. 94, 176 S.E.2d 161; David A. Logan & Wayne A. Logan, North Carolina Torts, \u00a7 7.30, at 169 (1996) (\u201cMany of the [North Carolina proximate cause] cases could have been decided differently.\u201d) We further recognize that it is only in the rarest of cases that our appellate courts find proximate cause is lacking as a matter of law. See Hairston, 310 N.C. at 235, 311 S.E.2d at 566. However, the law of proximate cause \u201c \u2018cannot be reduced to absolute rules.\u2019 \u201d Sutton, 277 N.C. at 108, 176 S.E.2d at 169 (quoting Prosser, supra, \u00a7 50, at 288). This is one of those rare cases where \u201cbecause of convenience, of public policy, of a rough sense of justice, the law arbitrarily declines to trace a series of events beyond a certain point.\u201d Palsgraf, 162 N.E. at 103 (Andrews, J., dissenting), quoted in Wyatt, 57 N.C. App. at 59, 290 S.E.2d at 791; Westbrook, 105 N.C. App. at 68, 411 S.E.2d at 654 (citation omitted) (\u201cproximate cause is to be determined on the facts of each case upon mixed considerations of logic, common sense, justice, policy and precedent\u201d).\nWe conclude that given the very specific and novel factual scenario presented by this case, defendant\u2019s alleged negligence was not the proximate cause of plaintiff\u2019s injuries. Therefore, the trial court should have granted defendant\u2019s directed verdict motion made at the close of all the evidence.\nHaving determined that the trial court erred in failing to grant a directed verdict in defendant\u2019s favor based on the issue of proximate cause, we need not address defendant\u2019s remaining assignments of error.\nBecause we find that the trial court erred in failing to grant defendant\u2019s directed verdict motion, we reverse the order of the trial court denying a JNOV and remand with directions for the trial court to enter judgment in defendant\u2019s favor.\nReversed and remanded.\nChief Judge EAGLES and Judge HUNTER concur.", "type": "majority", "author": "TIMMONS-GOODSON, Judge." } ], "attorneys": [ "Smith, James, Rowlett & Cohen, L.L.P., by Seth R. Cohen, and Gordon & Nesbit, P.L.L.C., by L. G. Gordon, Jr., for plaintiff-appellee.", "Pipkin, Knott, Clark & Berger, L.L.P, by Bruce W. Berger, and Smith, Helms, Mulliss & Moore, L.L.P., by James G. Exum, Jr., Matthew W. Sawchak and Hampton Y. Dellinger, for defendant-appellant.", "Kilpatrick Stockton, L.L.P., by Noah H. Huffstetler, III, for North Carolina Psychiatric Association, American Psychiatric Association, American Medical Association, North Carolina Medical Society, North Carolina Psychological Association,. North Carolina Hospital Association and American Psychological Association, amici curiae." ], "corrections": "", "head_matter": "WENDELL JUSTIN WILLIAMSON, Plaintiff v. MYRON B. LIPTZIN, M.D., Defendant\nNo. COA99-813\n(Filed 19 December 2000)\nNegligence\u2014 psychiatrist \u2014 patient care \u2014 no proximate cause \u2014 injuries too remote in time\nThe trial court erred by failing to grant defendant psychiatrist\u2019s motion for a directed verdict and thereafter his motion for judgment notwithstanding the verdict in an action where plaintiff, a twenty-four-year-old law student and defendant\u2019s patient, sought damages based on defendant\u2019s alleged negligent treatment of plaintiff\u2019s mental illness which allegedly caused plaintiff to randomly shoot and kill two people eight months after plaintiffs last session with defendant despite never expressing any intent to do so, because: (1) there was no showing of proximate cause of plaintiff\u2019s injuries when there was no evidence that plaintiff posed a threat of violence to others which would in turn lead to injury, plaintiff\u2019s own expert stated he was not sure that he would go so far as to conclude that plaintiff\u2019s dangerousness to himself or others was foreseeable, another of plaintiff\u2019s experts also testified that it was not foreseeable that plaintiff would kill others, and plaintiff\u2019s own behavior prior to or at the time of defendant\u2019s retirement in no way indicated that he would become violent; (2) plaintiff\u2019s injuries were too remote in time and the chain of events which led to plaintiff\u2019s injuries was too attenuated for defendant\u2019s actions to be the proximate cause of plaintiff\u2019s injuries of being wounded during a shootout, being tried for capital murder, being committed to a mental institution, and not being able to continue his legal studies or pursue a possible career; (3) North Carolina courts are reluctant to hold a person liable where the chain of events which led to the resulting injuries is unforeseeable, remote, and attenuated, even though some injury to plaintiff was possible; (4) evidence of risk factors for potential violence such as gun ownership, being under a certain age, or being of a certain gender, implicates a large portion of the population and is insufficient in and of itself to prove foreseeability; (5) the uncertainties in diagnosing diseases of the human mind and predicting future behavior were further hampered by the setting in which defendant observed plaintiff, which was an outpatient student health care facility intended for short-term treatment; and (6) public policy concerns show that imposing liability on a psychiatrist in an outpatient short-term care setting for the actions of a patient that are at most based on risk factors and not foreseeability would have adverse affects on psychiatric care when North Carolina\u2019s policy on the mentally ill promotes less restrictive methods of treatment and more patient autonomy.\nAppeal by defendant from order entered 4 September 1998 by Judge Wade Barber in Superior Court, Orange County, and from judgment entered 7 October 1998 and order entered 31 March 1999 by Judge James C. Spencer, Jr. in Superior Court, Orange County. Heard in the Court of Appeals 17 April 2000.\nSmith, James, Rowlett & Cohen, L.L.P., by Seth R. Cohen, and Gordon & Nesbit, P.L.L.C., by L. G. Gordon, Jr., for plaintiff-appellee.\nPipkin, Knott, Clark & Berger, L.L.P, by Bruce W. Berger, and Smith, Helms, Mulliss & Moore, L.L.P., by James G. Exum, Jr., Matthew W. Sawchak and Hampton Y. Dellinger, for defendant-appellant.\nKilpatrick Stockton, L.L.P., by Noah H. Huffstetler, III, for North Carolina Psychiatric Association, American Psychiatric Association, American Medical Association, North Carolina Medical Society, North Carolina Psychological Association,. North Carolina Hospital Association and American Psychological Association, amici curiae." }, "file_name": "0001-01", "first_page_order": 31, "last_page_order": 49 }