Table 2

R&S Cases Reflecting the Importance of Accurate Patient Assessment

CaseRelevant Findings
Scherer v. Waterbury, 2000 Conn. Super. LEXIS 481 (Conn. Super. Ct. February 22, 2000)53Treatment providers' policies were held to violate the Americans with Disabilities Act (ADA). Crisis center physician had directed that emergency room staff forcibly detain a female patient who grew upset at being asked if she had been raped. There was no indication that the patient had suicidal or homicidal ideation. The patient was placed in seclusion and forced to strip in front of a male security guard. She was not seen by a doctor until more than an hour later, when she was found not to be a danger to herself or others and released by the hospital. Demonstrates importance of trauma-informed care, determining history of trauma, and accurate/thorough risk assessment before ordering R&S.
Hopper v. Callahan, 562 N.E.2d 822 (Mass. 1990)54The patient died when an ectopic pregnancy was misdiagnosed as gastroenteritis, and the patient was placed (and ignored) in a seclusion room. Seclusion orders were continually renewed without examination by a physician, despite continued complaints of abdominal pain. The court wrote: “The two doctors could be found to have applied no medical judgment at all in entering the seclusion orders and to have abdicated any responsibility for investigating Hopper's medical condition, leaving the judgment concerning seclusion and medical care in each instance to inadequately trained, overworked staff” (Ref. 54, p 828).
Dolihite v. Maughon, 74 F.3d 1027 (11th Cir. 1996), cert. denied, Dolihite v. King, 519 U.S. 870 (1996)55The 11th Circuit affirmed the lower court's denial of qualified immunity for a social worker, noting sufficient evidence for a jury to find that she had acted with deliberate indifference toward a teenage patient's self-injurious behavior. The patient was placed in R&S and attempted to hang himself, (causing permanent brain damage) after his observation status was reduced. Social worker had also failed to communicate effectively with other staff about the patient's risk of further self-harm. The patient had engaged in multiple suicidal gestures and attempts before/during hospitalization and had a family history of suicide, but clinicians had not taken his suicidal ideation seriously. He was viewed as “manipulative”; the social worker opined that he enjoyed the “shock value” of talking about suicide. A previous hanging attempt was noted in the time-out record but ignored.