Mental health resident blinded from self-inflicted injury

This case involves a twenty-one year-old male patient with a past medical history of pervasive developmental disorder, moderate mental retardation and various behavioral issues. The young man had been residing in a group home since he was seventeen years of age – for approximately four years leading up to the time of incident. The patient had a known tendency to self-injure. His family became increasingly concerned about his safety and welfare. They had asked the facility management and treating physicians to ensure that the young man would wear a helmet at all times. The patient repeatedly inflicted injury upon himself by banging his head against hard objects resulting in a total of nine hospital visits resulting from self-inflicted head injuries. During the final self-inflicted head injury, the young man developed total and permanent blindness as a result. The facility never monitored him for injury, nor did they offer to allow the young man to wear a helmet as this was against their policy and they were likely unprepared to deal with a man in this condition. The patient’s family had asked on numerous occasions for the boy to either be transferred to a different facility that was better equipped to accommodate his needs; or, to have the young man wear a helmet. Unfortunately, neither request was acknowledged. The facility advised the parents that this was a “non-restraint” facility – and they would not adhere to the family’s requests. Instead, whenever the patient would inflict harm upon himself, the facility staff was advised to simply call 911 – and to not interfere in any way. Unfortunately, the patient’s family lacked the means needed to transfer the patient to a better equipped establishment.

Question(s) For Expert Witness

1. Given this young man's condition and tendency to self-inflict injuries, was it beneath the standard of care for this facility to fail to monitor his behavior, order him to wear a helmet or move him to a better equipped facility?

2. What is your level of experience in providing treatment regimens for patients who are prone to self-inflicted injury and suffering from mental illness or developmental disorders?

Expert Witness Response E-006013

From the information provided, this is below the standard of care and the facility needs to protect their patients and maintain a safe environment. Transfer to another facility is reasonable if the present facility could not maintain a safe environment. I work clinically with patients on the adolescent and child inpatient psychiatric unit where there are a number of patients who self-injure. I also work with a facility that treats children in state custody and a good portion of them have self-injured. I also have a busy outpatient eating disorder clinic in which a number of the patients self-injure. With regard to developmental disordered patients, I care for them when I rotate through the inpatient unit and a number of them self-injure.