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Serious Injuries

We receive this transfer from an outlying hospital for a neurology evaluation. The patient is in his 30s and was out at the bars when he was hit in head with beer bottle during an altercation.

Since that event, he has complained of dizziness, headache, loss of vision in one eye, pain all over his body, and repeatedly running out of pain medications. He had multiple CT scans and an MRI looking for causes of his symptoms at the referring hospital. All were normal. He also had multiple x-rays and physical exams without positive findings.

He went back to the emergency department and was reportedly “pissing himself” and “s**tting himself” – as in he was sitting on the couch watching a movie and didn’t know he urinated on the couch until his girlfriend told him that she felt something wet on the floor. Also reportedly only knew that he soiled himself when he went to take a shower and noticed his underwear contained a present.

The ED physician at the transferring facility took good notes. The medical records showed that at the first visit, he was on his cell phone yelling at police why the person who threw the beer bottle at him wouldn’t be charged with a crime. After he got off the phone, he reportedly told a nurse that he had to have a “serious injury” in order for it to be further prosecuted. A cut to the head from a beer bottle wasn’t classified as a “serious injury.”

The patient never seemed to have soiled clothing in the ED and he was able to walk back and forth to the bathroom without problems – even though he couldn’t tell when he needed to go to the bathroom. He also failed several tests for malingering in the hospital that sent him to us.

I had to smirk just a little when I watched the well-tattooed muscular patient transfer from the ambulance stretcher to the bed holding a cell phone to his ear … and wearing an adult diaper that the previous emergency department had placed on him for the ride.

The neurologist discharged him from the ED after finding no abnormalities … and after he failed the same tests for malingering in our ED.

Still no criminal charges, I’m going to guess.


  1. Wow, now that is some dedicated malingering, taking it all the way to adult diaper level.

  2. So this guy is BS…but just to play devil’s advocate…did he have any signs of cauda equina and/or get an MRI of his spine at some point?

  3. So, how do you test for malingering?

    Just curious, in case I some day want to malinger (although frankly, I can think of better places to malinger than in a hospital!)

  4. Should have taken the act all the way. It is no wonder he got his ass beat when he couldn’t even keep up the pretense of incontinence.

  5. We had a guy similar to this- although not seeking to file a lawsuit, but would pee and/or soil himself while in ED. This was reported to not ever happen at home, but always occurred in the ED. Multiple tests negative as well.

    @steve- per post- patient had at least 1 MRI, likely more.

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