Theo W.: Chronicle of an announced death in a psychiatry

Theo suffered from Asperger's syndrome and, on the advice of the treating psychologist, was presented and admitted to the child and adolescent psychiatric unit of the Psychiatric Services Aargau (PDAG) in May 2020. His behavioral problems had been accentuated by the situation during the Corona pandemic and the stress at school, and his parents no longer knew how to deal with them. For a long time, the psychiatrists at the PDAG were not sure what problems Theo had. In the end, they wavered between an obsessive-compulsive disorder and psychosis, and Asperger's syndrome was hardly mentioned. Over time, Theo developed more and worse compulsions there. Attempts to bring him home failed. After an incident (Theo pushed his mother) he was finally transferred from the child psychiatric ward to the adult ward in a spontaneous action on November 18, 2020. This was because he showed increased, mostly verbal-aggressive behavior and one was overwhelmed with his behavior in the KJP no longer manageable. The change was too fast for Theo as a person with Asperger syndrome and he also missed the familiar nurses. When asked by his mother why he was showing these unacceptable behaviors, Theo said several times that the medication made him feel nothing - it was so bad that he was trying to feel fear again.

According to the parents, "disaster took its course" in the adult department. The parents were told relatively quickly after admission that Theo would have to "wean himself off" them. Because he would become upset when the parents came, visits would be allowed only once a week. Later, because of the restrictions during the Corona pandemic, visits were banned altogether for a time. The parents were also rarely allowed to talk to him on the phone.

Theo had appointed his parents as confidants in writing. Nevertheless, after a certain period of time, the adult psychiatry failed to involve and inform the parents regarding treatment and changes in medication, etc. Many legal documents were not handed over. Moreover, the parents were not consulted when the placement was extended on December 22, 2020.

According to the BROESET prognosis tool for assessing the risk of violence, Theo had a very low potential for violence. Nevertheless, he was isolated due to his behavioral problems. According to the files, he was in an isolation cell for approximately 23 hours on most days from Nov. 29, 2020, to Dec. 30, 2020. From the end of November 2020, i.e. for more than 30 days, he was continuously in an isolation room. This is despite the fact that the sickening effects of such isolations are very well researched. They include:

• Anxiety, panic attacks, depression, anger, raging rage, perceptual disturbances to the point of total confusion, sensory disturbances, hallucinations, paranoia, psychosis, self-harm, and suicide.
• The practice of "long-term solitary confinement" - solitary confinement lasting more than 15 consecutive days - is absolutely prohibited by the Nelson Mandela Rules (Rule 43). Nevertheless, this practice, which is detrimental to health, continues to be used regularly in Switzerland, sometimes for months or years.
• The UN Special Rapporteur Nils Melzer had criticized Switzerland particularly harshly for this practice in the Brian case: "Any exceeding of the 15 days violates the prohibition of ill-treatment," Melzer said.
• Contrary to a prevailing misconception in Switzerland, this prohibition does not only refer to "solitary confinement" in which sensory perception is deliberately impaired (sensory isolation), but explicitly to any form of solitary confinement. This means any segregation of the prisoner for at least 22 hours per day without real interpersonal contact. Theo was isolated in solitary confinement for over 30 days. He had never committed a crime.

In Theo's case, the negative consequences of this long isolation were on record. He was seen to be hurting himself. Nevertheless, those responsible left him in isolation. In the KJP reports, Theo was still described as humorous and loving and it was noted that Theo needed a lot of walks and had a high urge to move. According to the care history reports, Theo injured himself a first time as early as November 2020. This was followed by continuous self-injury on record beginning on 12/21/2020, which was over 3 weeks into isolation. Daily, Theo threw himself on the floor and hit his head several times and under observation of the nursing staff. Despite visible (and documented in nursing progress notes) head injuries and numerous hematomas all over his body, he was not delivered to a hospital. For example, on 12/29/2020, the nursing progress report states, "Patient was then attended to for 15 minutes via peephole 1:1 and dropped nine times. Three times from a squatting position and six times from the edge of the bed."

On 30.12.2020, Theo was found unconscious in the isolation room. He was taken by helicopter to the University Hospital in Zurich. The doctors told the parents that the condition of Theo's brain meant that he had no chance of living. On January 2, 2020, Theo died from his brain injuries. Theo should never have been in the isolation room for so long.

The parents reported their son's death to the Department of Health of the Canton of Aargau and the Department has initiated a supervisory procedure against PDAG in 2021 regarding both the organization and their son's case. This has not yet been completed. The public prosecutor's office has opened investigations into intentional homicide under Article 111 of the Swiss Penal Code (StGB) against the head physician and the senior physician.

The human rights lawyer Philip Stolkin supports the parents and leads the proceedings. According to Stolkin, it was the unkindness in dealing with Theo, the inhuman arrogance, the isolation and the self-righteousness of the doctors that cost Theo his life.

Case chronicle Theo W.

1. First years of life

• Theo was born in December 2002 in Munich, where he lived for a while with his parents and brother. Early on, his parents noticed that Theo had difficulty understanding and following certain social norms.
• At the age of four, the family moved to Australia for three years. Theo learned English and was well embedded. Attention, something has been edited out here
• At the age of about 7, Theo came to Switzerland with the family.

2. School years and Asperger's diagnosis

• Theo attended elementary school and then also managed the transfer to the district school. In the last class of the district school Theo started to panic. He put himself under enormous pressure to perform, because he urgently wanted to go to the cantonal school. The situation came to a head and the parents decided that he needed a break. Because he had been doing so well in Australia, his parents sent him to Australia for six months and then to Canada for a six-month exchange year. From Australia, the school soon got feedback that Theo had autism and it should be clarified.
• When he came back from Canada, the mother arranged a clarification for autism.
• On 7/17/2019, Theo was diagnosed with Asperger's Syndrome.
• The parents decided to take Theo to a private school in Zurich, where smaller classes and fewer subjects were needed for the Matura.
• The Corona pandemic brought the situation to a head and it all became too much for Theo. A psychologist advised the parents that they should take Theo to PDAG.

3. Entry into the Psychiatric Clinic Königsfelden PDAG (May 2020).

• The voluntary admission to the clinic was very difficult for Theo as a person with Asperger syndrome.
• For a long time, the doctors at PDAG were not sure what problems Theo had. In the end, they wavered between obsessive-compulsive disorder, psychosis, or schizophrenia. However, the autism spectrum syndrome was hardly included in the considerations and clarifications.
• Theo got more and more and worse compulsions. He kept stepping into rooms of fellow patients until one of them became so enraged by it that he knocked out a corner of one of Theo's teeth. Theo began to make threats and also to write to acquaintances, to send them, but to delete the messages immediately. He kept saying that he was not serious, there was nothing to be afraid of.
• The attempt to bring him home failed.
• The mother's pleas to stop the medication were not responded to.

4. Admission to the adult ward (November 2020).

• Finally, on November 18, 2020, he was transferred from the child psychiatric ward to the adult ward in a spontaneous action after an incident (Theo pushed his mother). This was because he showed increased, mostly verbal-aggressive behavior and they were overwhelmed with his behavior in the KJP. This change was unprepared and too fast for Theo as a person with Asperger syndrome. He missed the familiar caregivers and adolescents. The night of the transfer, Theo did not settle down and the situation escalated because he wanted to go back to his usual ward.
• When the mother asked Theo why he had to show these unacceptable behaviors, he said several times that he didn't feel anything anymore because of the medication and that it was so bad that he tried to get scared again.
• The nursing report states on 11/26/2020, the nursing staff and patients saw Theo banging his head against the wall.

5. Isolation room (29. November 2020 - 30. December 2020)

• Theo was moved to an isolation room on Nov. 29, 2020.
• The new environment was very difficult for him to accept as a person with Asperger syndrome. He was stressed by the strange caregivers and fellow patients. In isolation he wet himself and he had to wear diapers. After days of isolation, he began to smear feces.  
• The bathroom including the toilet was locked several times or the water was turned off. This was for a variety of reasons, for example, the water was turned off because Theo had developed a compulsion to shower.
• On 05.12.2020, the nursing report states that the bell system seemed to be defective and it could not be determined whether Theo had rung the bell during the night. On 12/6/2020, on the other hand, the nursing report says: "Could not implement that he rang the bell before and then could go to the toilet."
• He suddenly made statements with sexualized content and things which, according to the mother, were completely atypical for him.
• The isolation room had a frosted glass window that prevented him from seeing outside. After a week of isolation, Theo developed a rare eating disorder with feces called pica syndrome.
• The parents were told that Theo would have to "wean" himself off the parents. Because he would get upset when the parents came, visits would only be allowed 1 time per week for 30 minutes. Later, due to the measures taken during the Corona pandemic, visits were completely prohibited for a time. The parents were also rarely allowed to talk to Theo on the phone. When the parents called, Theo was not brought the phone into the room. He was told he had to call back on his own. At that time, Theo no longer had a cell phone and hardly had the energy to make phone calls outside his room.
• Despite the well-researched sickening effects of such long-term isolation, Theo was in isolation for over 30 days.

6. Prolongation of the placement and self-inflicted injuries (December 2020)

• On 22.12.2020 the placement was extended without the parents being involved in this decision and although Theo had appointed his parents as confidants in writing.
• Also on 22.12.2020, the doctor's notebook states: "Pat. has swollen feet and numerous hematomas on buttocks, leg and arm. At first glance, nothing seems to be broken (...) Upon further inquiry (...) the pat. confirms having self-inflicted injuries (jumping on the toilet)".
• Theo inflicted more and more self-inflicted injuries on himself, which were also recorded in the files. He repeatedly let himself fall on the floor or on the toilet and off the edge of the bed. He was not hospitalized despite head injuries and numerous hematomas all over his body.
• On 12/27/2020, a report states, "On PP, Pat. appears severely motor slowed and also seems to have difficulty with posture. Pat. goes to ward with bent posture. [...] Pat. continues to drop to the floor in the room and hits his head several times. When asked, expresses that he does not want to tell PP why he is doing this. Each time he is contacted, he asks if he has to go to the hospital. Patient appears very distressed to PP."
• On 12/29/2020, the nursing progress note states, "Patient was then cared for for 15 minutes via peephole 1:1 and dropped nine times. Three times from a squatting position and six times from the edge of the bed. Pat. Was then taken out of isolation on a trial basis on a recurring basis and escorted on the ABtl. By PP. (...) Pat. then falls in the course within two hours approximately every minute to half a minute (...). The temporary office can not send staff to the mission and the regular team can not ensure 1:1 care with the amount of work. Pat. is monitored approximately every 5-10 minutes."

7. Theo is found unconscious (30.12.2020)

• Theo continues to throw himself to the floor, according to nursing reports. He complains of pain all over his body. According to the report, Theo comments on his behavior that he would feel empty if he did not throw himself off the bed. It is observed that Theo can neither internally nor motorically come to rest and appears to be suffering overall.
• When the nurse re-enters the room around 2:40 p.m., Theo is unconscious on the floor in the isolation room.  The ward team is alerted and Theo is positioned in a stable lateral position. Theo is intubated and flown by helicopter to Zurich University Hospital. The doctors told the parents that the condition of Theo's brain meant he had no chance of living.

8. Theo passes away (02.01.2020)

• Theo passed away from his brain injuries on January 2.

9. Proceedings against PDAG

• The parents reported the death of their son to the Department of Health of the Canton of Aargau in April 2021 and the Department has initiated supervisory proceedings against PDAG, both on the organization and on the case of their son. The public prosecutor's office has opened investigations into intentional homicide under Article 111 of the Swiss Penal Code (StGB) against the senior physician and the physician in charge.
• Human rights lawyer Philip Stolkin is supporting the parents and leading the case. According to Stolkin, it was the unkindness in dealing with Theo, the inhuman arrogance, the isolation and the self-righteousness of the doctors that cost Theo his life.

10. Indictment (23.04.2025)

• The investigation into Theo's case was concluded on 23rd April 2025.
• The public prosecutor's office has brought charges.
• It is charging a senior doctor and the senior consultant with wilful and negligent homicide by omission. It demanded a six-year prison sentence against the senior doctor and a two-year suspended prison sentence against the senior consultant.