Medicolegal Problems of Elopement from Psychiatric Units

Abstract

Elopements from psychiatric units are a frequent but usually low-grade risk. However, they are sometimes followed by harmful consequences, for which the psychiatrist and the hospital may be held liable. We describe management methods developed to reduce such liability. These include a structured observation system and procedures to return elopers to the hospital or to refer them for community-based treatment. Data on 105 elopers and 360 controls were gathered and analyzed. Acceptance of some risk of elopement is inevitable on wards that follow the principle of treatment in the “least restrictive alternative.”

Absconding Behaviour: an Exploratory Investigation in an Acute Inpatient Unit

“…Absconding prolongs treatment and places the patient and members of the public at risk [6]. However, the low rate of serious incidents reported should not give rise to complacency.…”

“…Despite conflicting results, AW O L behaviour appears to be associated with patients who are younger [3,6], legally detained [3,11], and who have a diagnosis of schizophrenia [3,12]. Despite conflicting results, AW O L behaviour appears to be associated with patients who are younger [3,6], legally detained [3,11], and who have a diagnosis of schizophrenia [3,12].…”

Absconding: a literature review

“…When things do go wrong, there is a possibility that legal action may be taken. Molnar et al . (1985 ) identified five cases in the US courts in which compensation had been sought for the consequences of absconding: two cases where patients had been struck by cars, one suicide attempt, one assault and one murder.…”

Development and Implementation of An Emergency Department Observation Unit Protocol for Deliberate Drug Ingestion in Adults – Preliminary Results

“…Little information is available on patient elopement, and no data has been published on elopement from the emergency department (13)(14)(15)(16). A data analysis of the sentinel event Development of an observation unit ingestion protocol 503 system and Mayo Clinic security records demonstrated a total of 16 events over a 24-month period, for an approximate rate of 1.1 elopements per 10,000 emergency department patients seen.…”

“…Likewise, individuals with evidence of chronic toxicity are not ideal observation unit candidates due to the potential for significant protracted toxicity. Seventeen patients in the current study were excluded from EDOU admission due to the presence of minor symptoms, specifically mild CNS depression (defined as a Glasgow Coma Scale of [13][14]. Fifteen of these patients were admitted to a critical care setting but might otherwise have been appropriate for the EDOU Deliberate Ingestion Protocol.…”