The key issues
The key issues in this case includes the failure to:
- Recognise clinical symptoms and take appropriate action
- Arrange referral to hospital
- Conduct adequate assessments
- Monitor patient’s health status
The background
The case relates to a nurse (respondent) who worked at a correctional facility in Queensland (Facility).
On 8 October 2016, the respondent was on duty along with five other nurses and had the longest experience of working as a nurse at the facility, bar one other nurse. The tribunal found this, along with her previous work for 8 years at the facility as a corrective services officer (CSO), gave the nurse some practical authority.
The allegations relate to the respondent’s care of a prisoner (patient) who was hit on the head with a mop bucket in the exercise yard at the Facility.
At around 8.30am, the respondent assisted in transporting the patient to the health centre at the Facility, where observations were taken and the respondent administered analgesia.
Around 11.00am, the respondent saw another nurse cleaning up the patient’s vomit, at which time he was lying on the floor, crouched over and did not seem to be making any spontaneous movements. The tribunal observed from the video footage shown to it that, upon moving the patient, he looked unconscious, but the respondent failed to take any neurological observations.
The tribunal found that the respondent failed to recognise the signs of the patient’s deterioration and that she should have intervened and facilitated his immediate transfer to hospital.
At about 1.00pm, the respondent attended the patient’s bedside again and, while another nurse took his observations, neither took his neurological signs, with the video showing no obvious spontaneous movements of the patient. The progress notes written by the respondent record that the patient had essentially normal observations and was cleared to return to his cell. The tribunal found that the note was wrong and the video revealed that the patient was seriously unwell.
When two CSOs took the patient back to his cell – past the respondent’s desk – the patient was lying on the floor and there did not appear to be any spontaneous movement of the prisoner on the video.
At around 3.00pm, a CSO reported to the nurses that the patient had been incontinent of urine. Neither the respondent nor other nurses investigated his condition. At 4.40pm, a code blue was called for the patient, where he was lying on his back sweating profusely. The respondent observed that he was hot to touch and his pants were wet.
The respondent directed a CSO to obtain an ice pack and placed it on the patient’s groin, claiming it was done to reduce the patient’s temperature. The tribunal did not accept this evidence (and accepted the evidence of the expert witness) and found that the respondent took such action as she believed the patient was faking his symptoms.
A decision was then made to transfer the patient to the health centre at the Facility, for which he was wrapped in a sheet and carried down the stairs to a gurney. While doing so, the respondent clipped up a restraint on the prisoner and tightened it vigorously, which the tribunal considered to be rough handling.
Paramedics soon arrived to transfer the patient, but the respondent did not attend to brief the paramedics, instead attending another “code blue”.
It emerged that the patient suffered a subdural haematoma and was left with brain damage. He remained in hospital for six months following the incident and had significant brain damage. The tribunal found that it was reasonable to infer that the patient’s condition was made worse by the delays.
The tribunal observed that:
- the behaviour of the respondent that day was entirely consistent with a belief that the patient was faking his condition and this was the reason a transfer to hospital was not facilitated;
- the respondent failed to assess the patient as potentially having a high-risk head injury as the patient had been holding/rubbing his head, sought painkillers, had a deteriorating neurological condition, moved in a strange way on his bed, was unable to stand or walk and had vomited;
- there was little indication or remorse and a lack of insight into the wrongfulness of the conduct; and
- the respondent lied to the tribunal in her evidence.
The outcome
The tribunal found that the respondent behaved in a way that constitutes professional misconduct, reprimanded her, cancelled her registration and disqualified her from applying for registration for 12 months.
The implication
Practitioners should treat patient symptoms on face value and take action proportionate to their assessment of the patient’s symptoms as reported by the patient.
The decision Health Ombudsman v Fletcher [2021] QCAT 4 can be read here.
