Death of Dan Markingson

Dan Markingson (November 25, 1976–May 8, 2004) was a man from St. Paul, Minnesota who died by suicide in an ethically controversial psychiatric research study at the University of Minnesota while under an involuntary commitment order.

For nearly eleven years, University of Minnesota officials defended the conduct of its researchers, despite significant public criticism, numerous news reports, and pressure for an external investigation.

In the summer of 2003, when he was 26 years old, Markingson was living in Los Angeles, where he hoped to become a screenwriter.

During a visit to Los Angeles, Weiss became alarmed at changes in her son's behavior that suggested he was seriously mentally ill.

She persuaded him to return to St. Paul.

On November 12, 2003, Markingson spoke about an apocalyptic “storm” in which he would be required to murder people, including his mother.

As a result, he was admitted to a locked psychiatric unit at Fairview University Medical Center.

His treating physician was Dr. Stephen Olson, an associate professor in the University of Minnesota's Department of Psychiatry.

After starting Markingson on risperidone (Risperdal), an antipsychotic drug, Olson wrote in support of a petition for an involuntary commitment order that would send Markingson to Anoka Metropolitan Regional Treatment Center, a long-term state psychiatric hospital.

A judge granted the commitment order on November 17, 2003.

Two other clinicians examined Markingson as part of the commitment process and both noted Markingson's extremely disordered thinking.

Shortly afterward, Olson requested that the court grant Markingson a stay of commitment, which permitted Markingson to avoid involuntary confinement at Anoka as long as he agreed to abide by the Fairview University Medical Center treatment plan.

A judge granted that request on November 20, 2003.

Rather than simply treating Markingson, however, Olson asked Markingson to enroll in the AstraZeneca-sponsored CAFÉ study, which compared three atypical antipsychotic drugs.

The CAFÉ study was a year-long, double-blinded study aimed at patients experiencing their first episode of psychosis.

On November 21, 2003, one day after the stay of commitment was granted, Jean Kenney, a study coordinator, had Markingson sign an informed consent form for the CAFÉ study when his mother, Mary Weiss, was not present.

Weiss strongly objected to her son's enrollment in the research study, but her objections were dismissed.

Two weeks later, Markingson was discharged to Theo House, a residential facility for the mentally ill in St. Paul.

He was required to sign an aftercare agreement stating that he understood that he could be returned to involuntary confinement if he failed to take his study medication or keep his CAFÉ study appointments.

Over the course of the next five months, Mary Weiss became convinced that Markingson's condition was deteriorating and tried repeatedly to have him removed from the CAFÉ study.

She warned the University of Minnesota research team that Markingson was in danger of suicide.

On April 11, 2004, she left a voice mail message for the study coordinator, Jean Kenney, asking “Do we have to wait until he kills himself or anyone else before anyone does anything?” On May 8, Markingson killed himself with a box cutter, nearly decapitating himself.

Laboratory tests later revealed that he had been taking quetiapine (Seroquel), produced by AstraZeneca.

The University of Minnesota Institutional Review Board received a Serious Adverse Event report from Olson, but did not review any medical records or interview anyone other than Olson.

On July 22, 2005 the Food and Drug Administration issued an Establishment Inspection Report.

The FDA inspector, Sharon Matson, found no violations.

However, an investigation by the state Ombudsman for Mental Health and Mental Retardation found several areas of concern.

In a letter on June 17, 2005, the Ombudsman's office pointed out that patients under a civil commitment (involuntary commitment) order are especially vulnerable and need special protection.

The letter also noted a conflict of interest, since Olson had served as both Markingson's treating physician and the principal investigator of the study into which he recruited Markingson.

In January, 2007, Mary Weiss filed a lawsuit against the University of Minnesota, but a Hennepin County judge ruled that the university had statutory (or discretionary) immunity.

The judge allowed a malpractice suit against Olson to proceed, which was settled for $75,000.

The University of Minnesota then filed a notice to assess costs against Mary Weiss, demanding $57,000.

The university agreed to drop the demand if Weiss agreed not to appeal the immunity ruling.

The Markingson case was first brought to public attention when the St. Paul Pioneer Press published a 3-part series in May 2008.

The Pioneer Press series raised concerns about the financial ties Olson and his CAFÉ study co-investigator, Charles Schulz, the Chair of the Department of Psychiatry, had to AstraZeneca and other pharmaceutical companies.

In March 2015, an investigation by a state watchdog agency found a number of major ethical violations in the case, including serious conflicts of interest and financial incentives, poor oversight of the study, pressure on Markingson to join the study while he was in a highly vulnerable state, and a series of misleading public statements by university officials.

Shortly afterward, the university suspended recruitment into psychiatric research studies.

On April 9, 2015, Charles Schulz, MD, announced his resignation as Chair of the Department of Psychiatry.

Because of the many ethical issues involved in Markingson's story, it is now used as a case study in many university bioethics courses.

Dan Markingson was raised in St. Paul, Minnesota by his mother, Mary Weiss, and earned a degree in English literature from the University of Michigan.