Hospital Administration Expert Discusses Failure to Prevent Self-Harm in Patient

This case involves a female patient with autism as well as other developmental disorders who had resided in the same long-term care facility for a number of years. During this time, the patient was known to have attempted self-harm on several occasions, and had been identified as a risk to her own well-being. Despite this awareness by the facility’s staff, there were allegedly no procedures in place or precautions taken to prevent the patient from harming herself. Eventually, the patient was found with a bleeding head wound in a stairwell by facility staff after the patient had apparently flung herself down a flight of stairs. The patient died shortly after she was discovered.

Question(s) For Expert Witness

1. Do you provide long-term care for patients with autism?

2. What are some measures taken to prevent self-injury?

Expert Witness Response E-059564

I have over thirty years of experience working with people with a variety of intellectual and developmental disabilities, including autism. I have assessed hundreds of individuals to determine what supports they need to be successful and safe in the community. Those assessments are then translated into effective care plans and behavioral support plans. Self-injurious behaviors should be thoroughly addressed in care plans and behavioral plans. First, it's important to try and understand why the behavior is occurring. Sometimes it's related to pain. A medical workup is often indicated, especially if the person can't express pain verbally. Self-injurious behavior can also be a symptom of an unmet need that the person doesn't know how to express. Data should be collected and the behavior should be addressed through the care plan. Treatment approaches and interventions are very individualized and specific to the person. Some techniques I've experienced include increased support and early verbal and/or physical intervention; the use of a soft, or if necessary hard helmet, the use of a padded safe room when the behaviors are occurring, and identifying when the person is likely to engage in the behavior and finding alternative activities to substitute. These interventions are considered restrictive measures and in most states require approval from the regulatory agency and/or human rights committee.