Psychiatric Nursing Expert Discusses Violent Patient Death in Psychiatric Hospital

This case involves a death at a psychiatric hospital. On the date of the incident in question, a man was admitted to a psychiatric hospital by an ER physician who documented that the patient had expressed both homicidal and suicidal thoughts. The patient had been brought to the ER by police following a violent confrontation at the man’s home in which he fired shots at the officers as they approached his house. Nevertheless, the patient was given a roommate upon admission to the psychiatric hospital, despite knowledge on the part of the staff that the man was dangerous. Reportedly, the man began to act more erratically as the day progressed, even after being administered anti-psychotic medication. Eventually, the man’s roommate was found beaten to death. It was alleged that the hospital should have taken more extensive precautions with the dangerous patient.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in this case?

2. What are the proper steps and protocols when discovering a patient may be harmful to himself or others?

3. What could have been potentially done to avoid this outcome?

Expert Witness Response E-015138

I am certified through the American Psychiatric Nurses Association (APNA) as an Adult Psychiatric-Mental Health Clinical Nurse Specialist. I also currently serve as President of the Mental Health Association in my region and past President of the APNA, TN Chapter. As an Advanced Practice Nurse educated as a Clinical Nurse Specialist in psychiatric mental health nursing for 32 years, I have extensive experience in acute in-patient psychiatric hospital units. I have never had the experience of an inpatient death during this time. Most in-patient protocols reflect the need to provide a safe environment, free from items that have the potential to cause harm eg. sharps, cords, glass, belts, shoe-strings, medicines/drugs and other potentially harmful items. Upon admission of a suicidal or homicidal person, specific precautions post mental status exam may include but are not limited to the following measures: assignment (if available) to a video monitored area or a patient room close to the nursing station, one-to-one observation within arms reach, safety checks every 15 minutes documented by staff, de-escalation techniques for agitation, use of psycho-pharmacological medications, and if necessary restraints and seclusion. An actively homicidal patient should never be assigned a roommate jeopardizing the safety of another patient.

Expert Bio

This highly qualified expert has been practicing for 30+ years and she is a certified specialist in Adult Psychiatric Mental Health Nursing. She has an M.S. in Child and Family studies, and an M.S. in Community Mental Health nursing from the University of Tennessee. She has published 9 articles, has given presentations and lectures across the nation, and she has been awarded numerous honors for her work as both a clinician and an educator, including 'excellence in advanced practice' by the Psychiatric Nurses Association, TN chapter. She holds membership to numerous associations and formerly served as President of the Mental Health Association of East Tennessee. She currently serves as an Assistant Professor at a Nursing College and is adjunct faculty at a large University.