This case takes place in Mississippi and involves a psychiatric hospital staff member who was attacked by a patient. The attacker had a diagnosis of schizophrenia with a long a history of violence, but there were allegedly no policies or procedures in place to restrict or otherwise monitor his access to common areas. He was previously on Risperdal a few years ago, but stopped due to the development of gynecomastia. He was then placed on Abilify and other medication, but was not responding well to any them. The patient had previously demonstrated a fixation on this member of the hospital staff, following her around the common areas and, on occasion, had made threats of violence against her. Despite reporting this behavior to her supervisors, nothing was done to restrict the patient’s movement or otherwise protect the staff member.
Question(s) For Expert Witness
- 1. Please explain your qualifications to view this case.
- 2. Are you able to explain industry standards with respect to safety precautions involving patients with violent histories?
Expert Witness Response E-008957
I worked for 13 years at a state hospital where we had a fair percentage of patients with violent histories. I have also worked in other settings where violence could be an issue, including emergency departments and crisis intervention programs and in prisons and jails. As I see it the standard of care involves (a) conducting a thorough diagnostic assessment (b) conducting a risk assessment that collects both risk factors and mitigating factors related to aggression toward self and/or others and (c) engaging in appropriate treatment targeting both the psychiatric diagnosis and the risk factors. Steps (a) and (b) may involve more than simply interviewing the patient – often, seeking outside information is very helpful in understanding the patient and in creating the appropriate treatment plan. In this instance, it may have been prudent to order that the patient was restrained. As a rule, physicians are responsible for ordering restraints, but there are occasions where nurses on the front line first initiate a restraint to manage an acute and ongoing emergency and only after the situation is settled to contact the physician for an order. In this case, it is clear that the staff member’s complaints should have been listened to and acted upon sooner.
Expert Witness Response E-001060
I was the Clinical Director of a large state-run mental hospital for several years, and I had to deal with preventing patient on patient violence all of the time. I am able to apply industry standards, which have to do with the manner in which inpatients at a psychiatric hospital are completely dependent and at the mercy of the staff at such facilities, and there is no excuse for inappropriate contact between patients and staff. There must be policies in place to prevent violence and harm to the staff as well as patients. It is both the Physician and the Nurse’s responsibility to make sure these policies are followed and enforced in cases like this. Ultimately, however, based on the “Captain of the Ship” doctrine, the Physician is ultimately responsible, and something should have been done as soon as the employee registered her concerns about the patient’s behavior.