Murder by Medical Malpractice

The Sordid Story of Washington’s “Doctor” Linda Burfield Hazzard

by Ron Perey[ref]Ron Perey is a medical malpractice and personal injury lawyer and founder of Perey Law Group, PLLC, in Seattle, Washington. He received the Washington State Association for Justice’s Best Trial Lawyer award in 2011 and holds the largest personal injury verdict in the State of Washington ($46.4 Million, in 2011). Carla Tachau Lawrence, a Seattle lawyer, contributed substantially to this article.[/ref]

Linda Burfield Hazzard

Linda Burfield Hazzard (1867-1938)

In 1913, before medical malpractice law in the State of Washington had evolved, “Doctor” Linda Burfield Hazzard, a self-proclaimed (though State-licensed) drugless healer, was charged with first degree (premeditated) murder of a patient by intentional starvation. Hazzard deliberately accomplished this with her novel medical treatment of a fasting “cure,” which she claimed allowed the digestive system to rest.[ref]”Murder” is generally defined as the unlawful killing of another human being without justification or excuse. See, e.g., Hazzard was charged with first degree murder (with malice aforethought or premeditation, with the goal of monetary gain) but convicted of the statutory lesser included crime of manslaughter.[/ref] Ultimately, Hazzard was convicted of manslaughter for the patient’s death. Hazzard was a shrewd, sadistic, greedy serial killer. Few lawyers or doctors seem to have heard of this unusual and interesting piece of Washington’s medical-legal-criminal history in which a “doctor” was criminally prosecuted for premeditated murder of a patient by means of a treatment protocol.

Linda Burfield Hazzard was licensed by the State of Washington as a practitioner of some type of “healing arts” (a drugless healer).[ref]Today, one statute remains under the Chapter entitled “Drugless Healing”, RCW 18.36.035: “No person may practice or represent himself or herself as a drugless therapist without first having a valid license to do so.” Other statutes in this Chapter were repealed in 1987, and now drugless healers are licensed as naturopaths under RCW Chapter 18.3 6A. RCW 18.36A.090, which deals with requirements to be licensed as a naturopath, also provides: “Any person holding a valid license to practice drugless therapeutics under chapter 18.36 RCW upon January 1, 1988, shall be deemed licensed pursuant to this chapter.”[/ref] But because there was no real regulatory agency at the time, it is unclear what she was licensed to do. Her healing philosophy was based on the belief that all human illness (from a toothache to tuberculosis) derived from toxins in the body’s blood stream, or impure blood.[ref]At the time, there were many competing philosophies for treatment of illness. Drugless healing is a form of “alternative medicine,” which includes any healing practice that does not fall within the realm of conventional or allopathic medicine * drugs and surgery) performed by medical doctors (M.D.s), or which has not been shown to be consistently effective. Alternative medicine may be based on historical, cultural, or religious tradition with no scientific evidence to support the practice *also called complementary or integrative medicine). Some examples are: osteopathy, naturopathy, homeopathy, chiropractic, holistic, energy, acupuncture, traditional Chinese, herbal, bio-magnetic, applied kinesiology, brainwave entrainment, chelation therapy for atherosclerosis, iridology, live blood analysis, fasting, sunshine, fresh air, nutrition, heat, cold, ozone therapy, osseous or soft tissue manipulation, exercise hydrotherapy, enemas, meditation, relaxation and stress management, hygiene, reflexology, massage, Rolfing, Ayurveda, and prayer.[/ref] Consequently, her single cure for all illnesses, administered to patients in Seattle and at her Olalla Sanitarium, was to purge a patient’s blood of toxins, and the illness would be gone. The regimen consisted of: (1) a starvation liquid vegetarian diet (about four ounces, three times daily), lasting 40 days or more; (2) daily external massage (pummeling or beating the patient’s back and forehead); and (3) daily internal massage (multiple enemas involving as much as six quarts of water, lasting for hours). If the patient survived, he or she could conceivably leave Hazzard’s care. Unfortunately, as many as 40[ref]Estimates range from 12 to 40 victims of Hazzard’s starvation cure.[/ref] of Hazzard’s patients did not leave alive and may have been murdered by this preposterous starvation diet: hence, murder by medical malpractice.

Linda Burfield Hazzard was born in Minnesota in 1867. She had no medical training, though she may have had some experience as an osteopathic nurse and allegedly had worked as a licensed practical nurse in Minnesota before coming to the State of Washington. Nevertheless, she called herself “Doctor Hazzard,” insisting others call her “Doctor” (not the conventional “Mrs. Hazzard,” which she retorted was her mother-in-law), and the medical community loosely referred to her as such. She came to Washington in 1907, and established a sanitarium which she called the Hazzard Institute of Wellness and Therapeutics, located in the Wilderness Heights area of Olalla, a small logging town on the Puget Sound in the southern wilderness of sparsely populated Kitsap County. No telephones and probably no electricity existed there at the time. Olalla residents refer to the area of her sanitarium (which mysteriously burned down in 1935) as “Starvation Heights.”

In many Ways, Hazzard was ahead of her time in proselytizing for doctors to concentrate on preventing illness rather than curative treatment. She was operating in a man’s world of medicine, and the male-dominated medical establishment reviled and scorned her. She was very smart, articulate, independent, powerful, and persuasive, with many influential friends. She wrote a book entitled Fasting for the Cure of Disease (Harrison Publishing Co., 1908), which was widely circulated, created controversy in the medical community, and brought her worldwide notoriety as well as many curious patients, mostly apparent hypochondriacs.[ref]The book is still available in an electronic version,[/ref] But she was also a dangerous quack, an evil, greedy person, a thief, and a serial killer.

Doctor Hazzard’s “medical” practice in Washington came to an end in 1913, when she was charged with first degree murder and convicted of the lesser included offense of manslaughter for the death of Claire Williamson, a wealthy British heiress, spinster, and dilettante hypochondriac. Claire Williamson was murdered by medical malpractice (starvation) in 1911 under Hazzard’s regimen.[ref]The current statutes for murder and manslaughter are: RCW 9A.32.030, Murder in the first degree. “(l) A person is guilty of murder in the first degree when: (a) With a premeditated intent to cause the death of another person, he or she causes the death of such person or of a third person; or (b) Under circumstances manifesting an extreme indifference to human life, he or she engages in conduct which creates a grave risk of death to any person, and thereby causes the death of a person….” (Emphasis added.)

RCW 9A.32.050 Murder in the second degree. “(1) A person is guilty of murder in the second degree when: (a) With intent to cause the death of another person but without oremeditation, he or she causes the death of such person or of a third person….” (Emphasis added.)

RCW 9A.32.060, Manslaughter in the first degree. “(1) A person is guilty of manslaughter in the first degree when: (a) He or she recklessly causes the death of another person; or (b) He or she intentionally and unlawfully kills an unborn quick child by inflicting any injury upon the mother of such child….” (Emphasis added.)

RCW 9A.32.070 Manslaughter in the second degree. “(1) A person is guilty of manslaughter in the second degree when, with criminal negligence, he or she causes the death of another person….” (Emphasis added.)
[/ref] Both Claire and her sister Dorothea (“Dora”) Williamson enthusiastically submitted to Doctor Hazzard’s starvation diet on the same day, after reading her book, seeing a newspaper advertisement for her services, and meeting her in a downtown Seattle hotel. Dora survived Doctor Hazzard’s starvation diet, but just barely: she went from a healthy-looking, normal 34-year-old woman to a delirious, emaciated, skeletal bag of bones and skin weighing about 61 pounds, when rescued by her uncle and her childhood nanny, Margaret Conway.

It was the “trial of the century” in Kitsap County, making front page news each day, and the courtroom was packed with her supporters, her critics, and curious citizens. On February 4, 1912, after a three-week trial in Port Orchard, Kitsap County, conducted by a team of male prosecutors under a male judge (Yakey), Hazzard was convicted of manslaughter by 12 male jurors. She did not take the witness stand or testify in her own defense, though her lawyers strongly maintained her innocence throughout the trial. She claimed she would have told her story and defended her treatment if her jury had been comprised of women. On August 13, 1913, she was sentenced to prison for a term of 2 to 20 years.

Her primary defenses at trial were that her diet had “cured” hundreds of ill people; all patients were voluntary and willing; and those who died would have anyway. Traits that forecast her murder conviction were her arrogance and greed: assisted by her unethical lawyer and her crooked husband, Sam Hazzard, she often acquired her murdered patients’ land, money, jewelry, and assets after they died. Hazzard forged patients’ wills, stole their possessions (for example, rings, other jewelry, and clothes), or otherwise defrauded them. She somehow conducted her own autopsies and issued death certificates for her murdered patients, invariably ruling death was due to natural causes or diseases, such as cirrhosis of the liver. She quietly transported her dead patients’ bodies from Olalla by private boat to dispose of them with the help of a cooperative Seattle mortuary, E.R. Butterworth & Sons. That mortuary is now the site of Kell’s, a popular Seattle Irish pub.

Hazzard began serving her prison sentence in the Walla Walla State Penitentiary in December 1913, while appealing her conviction. The Washington State Supreme Court unanimously affirmed the conviction and sentence in a very well-written opinion, State v. Linda Burfield Hazzard, 75 Wash. 5, 134 P. 514 (1913) (Main, J ., writing; Crow, C.J., Ellis, Fullerton, and Morris, J .J., concurring). Distinguishing the crime from a civil action for medical malpractice, the Court held: [ref]The defendant is charged with the crime of murder in the first degree in that, with premeditated design, she did kill and murder Claire Williamson by the depriving and withholding from her of food and sustenance, etc., which produced death. This is not the charging of a crime by failure to perform a duty, but it is the charging that a crime was committed by an affirmative positive act. Under such a charge, it was not necessary to allege a duty to lhrnish food. But if such an allegation were necessary, it is plainly found in the information wherein it is said that Claire Williamson was in the care, custody, and control of the defendant who had undertaken to care for her and to provide sufficient food and sustenance to sustain life.[/ref]

Id., 75 Wash. at 15.

The Court affirmed the trial court’s decision to allow physician-witnesses to testify “in answer to hypothetical questions, as to the degree of medical skill and care used by the defendant in treating the deceased.” Hazzard complained this testimony tended “to prove the crime of malpractice, while the defendant was charged with murder in the first degree by the withholding of food.” The Court concluded that the testimony went to lesser included crimes within the charge of first degree murder: [ref]The law is unquestioned that the evidence introduced must either support or tend to support the crime charged in the information. In this case the defendant was charged with murder in the first degree by the withholding of food with the premeditated design to produce death. Within this charge are included two lesser crimes, that of murder in the second degree and manslaughter. If the defendant did not withhold food with a premeditated design, but did withhold food through failure to exercise that degree of care which the law imposes upon one practicing her profession, then she would not be guilty of murder in the first degree, but would be guilty of a lesser crime. The evidence therefore was admissible under the charge as laid in the information.[/ref]

Id., 75 Wash. at 19-20.

Hazzard served about two years in the state penitentiary in Walla Walla, Washington. Then, surprisingly, Washington Governor Ernest Lister granted her a full pardon in 1915, in return for her promise to leave the State of Washington. Apparently, he wanted her out of Washington because of the continuing publicity and pressure from her “friends.” Because she was pardoned, she requested that her license to practice healing arts be reinstated. The request was denied, and the Washington State Supreme Court affirmed the denial on appeal. State v. Hazzard, 139 Wash. 487, 247 P. 957 (1926) (Governor’s pardon did not operate to reinstate license to practice “art of healing”).

Hazzard moved to New Zealand for about two years, where she continued her work under the title of physician, dietician, and osteopath, allegedly continuing to kill several patients with her starvation diet. She quietly returned to Washington in 1920, discreetly setting up a school in Olalla to teach a form of homeopathic medicine, without openly administering her starvation diet to patients. Ironically, she died in 1938 in Olalla while undergoing her own starvation fasting cure regimen. She was 71 years old.

Though it is not possible to identify all the murdered victims of Hazzard’s starvation diet and greed (estimates range from 12 to 40), here is a partial list of Washington State victims:

  • Daisy Maud Haglund (1908), mother of Ivar Haglund, who became a famous Seattle entrepreneur and restaurateur with Ivar’s Fish & Chips. Ivar was only 3 when his mother died. Hazzard also treated Ivar after his mother’s death.
  • Ida Wilcox (1908).
  • Mrs. Elgin Cox (1908).
  • Blanche B. Tindall (1909).
  • Viola Heaton (1909).
  • Eugene Stanley Wakelin (1909), found with a bullet in his head. Maude Whitney (1910).
  • Earl Edward Erdman (l910), a civil engineer who left a detailed diary. C.A. Harrison (1911), publisher of Alaska-Yukon magazine.
  • Frank Southard (1911), lawyer.
  • Ivan Flux (1911), English gentleman.
  • Lewis Ellsworth Rader (l9ll), Washington legislator and publisher of Sound Views magazme.
  • Claire Williamson (1911), English heiress.
  • William Junile (1911).
  • Ida J. Anderson (1913), died after Hazzard’s conviction and before she went to prison.
  • Mary Bailey (1913), died after Hazzard’s conviction and before she went to prison.

Despite the number of deaths that occurred under “Doctor” Hazzard’s care, no one ever filed a civil lawsuit against her for medical malpractice or wrongful death. Medical malpractice lawsuits against doctors did not become practically feasible until the 1960s. Murdered patients and their families rarely, if ever, received justice. But see State v. Karsunky, 197 Wash. 87, 84 P.2d 390 (1938) (drugless healer, while masquerading as a qualified physician, willfully prescribed improper treatment for type 2 diabetes, resulting in manslaughter conviction); Kelly v. Carroll, 36 Wn.2d 482, 219 P.2d 79, 19 A.L.R.2d 1174 (1950) (drugless healer liable in wrongful death/medical malpractice case for failure to adequately diagnose and treat patient with symptoms of appendicitis; “if there was a possibility that it was appendicitis, [the drugless healer] had no right to gamble with [patient’s] life, on the theory that it might be something else”). “Doctor” Hazzard was never effectively held legally accountable, civilly or criminally, for her medical murders.

This tragedy would likely not happen today for the following reasons:

  1. “Doctor” Hazzard would not be licensed by the State of Washington to practice
    medicine or any type of healing arts.[ref]Under RCW 18.17.01 1, only a person licensed to practice medicine can use the label “doctor,” unless they also disclose “the description of another branch of the healing arts for which a person has a license”: “Definition of practice of medicine Engaging in practice of chiropractic prohibited, when. A person is practicing medicine if he or she does one or more of the following: (1) Offers or undertakes to diagnose, cure, advise, or prescribe for any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary, by any means or instrumentality; (2) Administers or prescribes drugs or medicinal preparations to be used by any other person; (3) Severs or penetrates the tissues of human beings; (4) Uses on cards, books, papers, signs, or other written or printed means of giving information to the public, in the conduct of any occupation or profession pertaining to the diagnosis or treatment of human disease or conditions the designation ‘doctor of medicine,’ ‘physician,’ ‘surgeon,’ or any combination thereof unless such designation additionally contains the description of another branch of the healing alts for which a person has a license: PROVIDED HOWEVER, That a person licensed under this chapter shall not engage in the practice of chiropractic as defined in RCW 1825.005.”[/ref]
  2. “Doctor” Hazzard would be sued for damages by a medical malpractice trial lawyer in a civil lawsuit.
  3. “Doctor” Hazzard would be held accountable legally and be put out of the medical business by a jury’s award of damages.
  4. “Doctor” Hazzard would be unable to purchase medical malpractice insurance.
  5. “Doctor” Hazzard’s dangerous starvation diet would be exposed to public scrutiny by our freedoms of information, press, and media.
  6. The modern medical-legal requirement that a health care practitioner obtain the fully
    informed consent of a patient before commencing medical treatment[ref]Laws of 1976, 2d Bk. Session, Chapwte; 56 § 10; RCW 7.70.030,’ RCW 7.70.050.[/ref] would be a major deterrent to her dangerous starvation diet. This law means that before commencing a medical treatment, a patient must first be fully advised of the diagnosis and the risks, benefits, and alternatives to any proposed treatment, including no treatment at all. RCW 7.70.050. That law did not exist in 1913.
  7. “Doctor” Hazzard would be prosecuted criminally for the harm she caused to patients and the unlawful practice of medicine.
  8. “Doctor” Hazzard would be prosecuted criminally for theft, fraud, or embezzlement.
  9. “Doctor” Hazzard would be sued and held liable for conversion, fraud, treble damages and attorney fees under the Washington Consumer Protection Act, RCW Chapter 19.86.
  10. “Doctor” Hazzard would be investigated by the Medical Quality Assurance Commission (see RCW 18.71.002) and hopefully would lose her license to practice.

However, as far as can be determined, Linda Burfield Hazzard’s conviction is one of only two instances in Washington legal history where a health care practitioner was charged With murder or convicted of manslaughter of a patient by a treatment protocol. See also State v. Karsunky, 197 Wash. 87, 84 P.2d 390 (1938) (in a bench trial, “Doctor” Karsunky was convicted of manslaughter in a patient’s death, but the conviction was overturned on appeal based on denial of a jury trial).

Though criminal prosecution of medical malpractice has been rare, more recently, some have advocated increasing this type of prosecution as a supplement to ineffective civil liability and disciplinary action. An event that highlighted this debate is the California trial and November 2011 conviction of Dr. Conrad Murray, mega-pop star Michael Jackson’s personal physician, for involuntary manslaughter (a form of murder While acting with “criminal negligence”) in Jackson’s drug-induced death.[ref] (reporting jury verdict). Murray’s trial is mentioned in Heidi A. Barcus, and Amy Cook, Criminal Medicine: When Malpractice Turns to Manslaughter, Feb. 9, 2010, Barcus summarizes previous research cataloging of criminal-medical incidents: “The prosecution of criminal medical negligence was once a relatively uncommon occurrence. Between 1809 and 1981, there were only around 15 reported appellate cases. James A. Filkins, With No Evil Intent: The Criminal Prosecution of Physicians for Medical Negligence, 22 J. Legal Med. 467, 472 (2001) [(describing nine appellate cases, and estimating from “15 or so” to “perhaps two dozen” more non-appellate cases during 20-year period of his research)] There are apparently no comprehensive statistics on the subject, but combined figures from recent law review articles have identified nearly 30 cases of criminal prosecution against physicians between 1981 and 2005. Diane E. Hoffrnann, Physicians Who Break the Law, 53 St. Louis U.L.J. 1049, 1082 (2009).” See also generally, e.g., E. Monico, R. Kulkarni, A. Calise, J. Calabro, The Criminal Prosecution of Medical Negligence, The Internet Journal of Law, Healthcare and Ethics, 2007 Vol. 5 No. 1, (discussing arguments for and against criminal prosecution of medical malpractice). Another famous case of homicide by treatment is People v. Phillips, 64 Cal.2d 574, 51 Cal. Rptr. 225 (1966), overruled on other grounds in People v. Flood, 18 Cal.4th 470, 490, fn. 12, 76 Cal. Rptr. 2d 180, 957 P.2d 869 (1998), in which a chiropractor was convicted of second degree murder in 1962 for reckless treatment of an eight-year-old child with eye cancer. The conviction was subject to numerous appeals, hearings, and retrial before being reversed by the California Supreme Court in 1966, due to an improper jury instruction on felony murder.[/ref] Most medical and other healthcare practitioners are careful, well-trained, ethical, and moral practitioners of their chosen field of care, and are neither charged with crimes nor sued for malpractice.[ref][/ref] However, many healthcare practitioners have been successfully sued for causing injury to and wrongful death of patients due to medical malpractice.[ref]See Kelly v. Carroll, 36 Wn.2d 482, 219 P.2d 79, 19 A.L.R.2d 1174 (1950) (drugless healer sued for malpractice for death of patient with a ruptured appendix; extensive discussion of drugless healers and why they are not “doctors”‘ defendant Carroll had a similar lawsuit that went to the Washington Supreme Court, Wilcox v. Carroll, 127 Wn.2d 1, 219 P.34 (1923)). See also Paul Jung, Peter Lurie, and Sidney M. Wolfe, U.S. Physicians Disciplined for Criminal Activity, 16 Health Matrix: J. of Law-Medicine 335 (Case Western Reserve L. Sch., Summer 2006)(study of physicians convicted of crimes, including murder and manslaughter, and disciplined by state medical boards or federal government between 1990-99).[/ref] By default, today the quality of healthcare and medical negligence is monitored and, in effect, “regulated” by lawsuits, courts, juries, and experienced medical mallpractice trial lawyers.[ref]An excellent novel published by Olalla resident Gregg Olsen in 1997, after five years of exhaustive research into the life of “Doctor” Linda Burfield Hazzard, was the source of much of the information in this article. Gregg Olsen, Starvation Heights (New York: Warner Books, 1997). See also Katherine Beck, Hazzard, Linda Burfield (1867-1938): Fasting Proponent and Killer (Oct. 26, 2006, rev. Oct. 1, 2009, Nov. 3, 2011); On July 6, 2012 the Travel Channel aired a bio-pic on “Doctor” Hazzard entitled “Starvation Heights.” Ron Perey of Perey Law Group served as the medical-legal commentator. See, or go to the Travel Channel’s “Dead Files” archive on your cable TV.[/ref]