This addiction psychiatry case involves a patient who suffered injuries at a addiction rehabilitation center located in Oregon. The rehab center conducted an assessment upon intake of the patient and they noted that the patient was suffering from “hallucinations” as result of his addiction to, and withdrawal from, alcohol. On one occasion, the patient was taken to the hospital because he was complaining of head pain and nausea. After returning from the hospital, the patient became increasingly erratic and was experiencing hallucinations. The patient was in a state of delirium and thought the building was on fire. The staff at the rehab center allowed him access to a restricted area on the third floor where he picked up a fire extinguisher and broke a window and jumped out. The man suffered severe bodily injuries. It is alleged that the rehabilitation staff was negligent and did not take the necessary measures to constrain the individual and prevent him from accessing restricted areas.
Question(s) For Expert Witness
1. Do you have extensive experience working as a director of a rehabilitation center?
2. What are the proper steps to take when an individual is displaying signs of delirium and hallucinations?
3. What kinds of care plans are in place that minimize a patient’s risk of self-harm?
Expert Witness Response E-009435
I have over 20 years of experience in the alcohol treatment and therapy field, and I have extensive experience as a facility/rehabilitation director of both inpatient and outpatient rehabilitation centers. As for the patient in this case, based on the alleged withdrawal symptoms noted, his mental health needed to have been part of the intake/bio-psychosocial assessment. A qualified mental health or clinical professional needs to assess the patient's potential for self harm based on reporting, behavior, and history. The next step, upon analyzing and consulting on the assessment, is to determine the severity and legitimacy of the alleged hallucinations to determine the patient's needs and subsequent level of care and supervision, all of which needs to be documented in the patient chart. As a facility director, I am astounded that this patient was allowed access to an unauthorized area. For a patient experiencing heightened symptoms of a psychotic nature to have access to any unsupervised or restricted area, or even access to a fire extinguisher, is highly irregular. Based on the assessment noted above, a clinically driven safety and care plan (Tx plan) is then established with clearly defined Interventions and objectives, denoting responsible staff (i.e. nursing department, clinical, medical, etc.) and specific time lines to the same. This plan need also list any risk variables (e.g. self harm, fall risk, absconding/flight risk, etc.) and a determination of the level of supervision required for the patient.
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