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.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.
