June 27, 2019 | 721 Views“Adequate” system of work found wanting in hospital patient’s attack on nurse

A 46-yr-old nurse overrun by an aggressive hospital patient has defeated her employer’s argument that it had an adequate system in place to prevent such an injury in which she had been adequately trained.

Lisa Ringuet – active, fit and weighing in at just 50kg – was on duty in the Young Adult Mental Health Unit at the Robina Psychiatric Hospital in August 2012 when she unlocked the nurse’s station door to enter the intensive care unit.

A young male patient with a known history of aggression and a high risk of escape had concealed himself near the other side of the entry. Unknown to Lisa, just a few hours earlier at around 3am, the patient was marked as needing a further risk assessment after a violent outburst.

The patient barged at the door as she opened it. Lisa pushed back until assistance arrived, suffering an injury to her lower back.

After periods off work, she retrained in a different health care field but was unable to continue full time work. She also developed a psychiatric condition from the incident but returned to work 16 – 24 hours per week in May 2015.

The hospital did not dispute – when the damages claim process was begun – that the incident had occurred or that an injury was sustained.

It answered the claim by asserting it had a perfectly adequate system in place and that there was no need for extra measures to have been taken on this particular occasion as Lisa had been fully trained in the steps she was required to take.

She was, so their argument ran, the cause of her own injuries by failing to check that there were no risk patients nearby by looking through the glass panel adjacent to the door which she denied to the court’s satisfaction.

The facts established that she was working in tandem with another nurse who was in the medicine room alone and was entering the secure unit to do a rubbish collection run.

The principal element of the hospital’s safety plan was that nurses were required in in the psychiatric ward intensive care unit to work “in pairs”.

But this did not mean that the pair had to work side by side. Rather, it merely required that each of them was to be aware of what the other nurse was doing and roughly where in the ward they were.

How such a policy could be relied on as the foundation of a safe system of work in dealing with aggressive and dangerous patients left some explaining to be done.

“Apart from the requirement to communicate with the other nurse and to inform each other of their whereabouts prior to isolating themselves with patients,” she was not provided with any other guideline for entering the intensive care unit.

Neither had Lisa received any training – other than a five-day induction course in 2010 – in how to deal with aggressive patients or with the particular characteristics of those in the intensive care unit at that time.

The employer called nurse’s credibility into question by demonstrating her inconsistent answers to various questionnaires.

While accepting that this “did not reflect well on the plaintiff”, Judge Catherine Muir in the District Court in Southport said that such answers were “equally consistent with the plaintiff being hardworking and determined to get herself back into the workforce while trying to overcome her injuries”.

Her Honour’s impression was that the plaintiff was “generally a credible and honest witness” but he was unable to conclude whether or not any particular warnings were given to Lisa about the patient when she started her shift.

She concluded that the patient got to the door while Lisa was putting her rubber gloves on, after looking through the viewing panel and before turning the lock in accordance “with the practice of the intensive care unit at the time”.

“On balance I accept the plaintiff’s evidence that it was her usual practice to look through the glass panel on the door”.

Noting that the hospital knew of the particular risk of this patient, Her Honour concluded that the risk of him trying to abscond “from the intensive care unit causing injury to a nurse along the way was obvious and reasonably foreseeable”.

“It follows and I find that the risk that the nurse might sustain an injury in trying to prevent the patient from escaping the secured area as the door was being opened was foreseeable and not insignificant in this case”.

But what could the hospital have done to prevent the injury?

The reasonable “and practical precaution available to reduce the risk was to require a security officer to be called and attend there to assist the nursing staff on each occasion they were required to enter the unit,” so ruled the judge.

“Given that security officers were employed at present at the hospital, such as system would not be too difficult or costly or implement”.

The extent of the plaintiff’s injury became a contest between neurosurgeons Scott Campbell on the one hand who assessed her injuries at 8% WPI, and Richard Williams who took the view that she was 0%.

Both specialists agreed that the plaintiff had an injury to her lumbar spine as a result of the incident, but Dr Williams was of the view that it had fully resolved “within six weeks”.

That said, Dr Williams accepted that the twisting movement during the course of the struggle may have caused “substructural” microinjury that does not typically show on MRI.

Her Honour preferred the evidence of Dr Campbell but found that the symptoms complained of were not as severe as the plaintiff alleged.

Psychiatrists, Dr Harvey Whiteford and Dr Malcolm Foxcroft considered that the 5% impairment they each attributed to her had largely been ameliorated to 0%, but both were of the view that she was at a risk of relapse if exposed to further trauma.

After all that medical evidence, general damages were assessed at mere $11k.

Noting that she should be accorded recognition for her sheer determination and tenacity for her return to work efforts, Judge Muir awarded $195k for past economic loss and for the future, $122k making a total assessment of $400k.

Ringuet v State of Queensland [2019] QDC 91 Muir DCJ, 6 June 2019

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