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Ontario's highest court has ruled that a Toronto psychiatrist who felt she could not admit a delusional man to hospital involuntarily must pay a $172,000 jury award to the family of a woman he killed -- his own sister.

The killing took place on Jan. 24, 1997, about six weeks after William Johannes was released from Humber Memorial Hospital by psychiatrist Rodica Stefaniu. Gripped by a floridly psychotic rage, Mr. Johannes stabbed his sister -- Roslyn Knipe -- 60 times before cutting out one of her lungs in the belief that she was possessed by the devil.

The case is thought to be the first in which a psychiatrist has been held civilly responsible for a killing committed by a psychotic patient she had released into the community.

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"Doctors are going to have to be very careful in future, especially in certain fields where a person's violent actions can lead to bodily harm and death," said Garry Barankin, a Hamilton lawyer with an interest in medical legal issues.

While it makes sense for doctors to be accountable when their decisions fall below an acceptable standard of care, "I still think it sets a dangerous precedent," Mr. Barankin said in an interview.

In seeking to uphold the jury award, lawyers Brian Horowitz and Amanda Potasky -- representing the victim's husband, Kalid Ahmed, and his daughters, Lailah and Lelise -- argued that Mr. Johannes was a seriously ill individual who would inevitably explode into serious violence.

The Ontario Court of Appeal stated firmly that there was solid evidence that, but for Dr. Stefaniu's decision to release Mr. Johannes, his 39-year-old sister would not have been killed.

Writing on behalf of Madam Justice Eileen Gillese and Mr. Justice Russell Juriansz, Mr. Justice Robert Armstrong said that the trial judge properly instructed the jury on the legal ingredients it was bound to consider.

Mr. Johannes, 31, had a long history of institutional care. He was involuntarily committed to Humber Memorial in 1996 after he became delusional and extremely paranoid, prompting Ms. Knipe to express concerns about threats he had made.

Mr. Johannes immediately refused treatment and had to be physically restrained by staff on numerous occasions in the months that followed.

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Dr. Stefaniu noted a deterioration in Mr. Johannes' behaviour that fall, but she did a turnaround on Dec. 4, when Mr. Johannes apparently became gentler and more communicative.

"She found him very appropriate, co-operative and with a great sense of humour," Judge Armstrong said. "During the assessment, he told the appellant that he had no intention of harming himself or anybody else, including his sister. He also told the appellant that all of his behaviour at the hospital had been 'staged and planned.' After Mr. Johannes was released, Ms. Knipe made the fatal mistake of letting her brother move in with her and her two daughters. Seven weeks later, she was killed."

In 1999, a judge found Mr. Johannes not criminally responsible for the killing and he was incarcerated in the Penetanguishene Mental Health Centre.

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