The patient subsequently commenced proceedings in the District Court of Western Australia against North Metropolitan Health Service alleging that the medication error constituted negligence and had caused her to suffer psychiatric harm. The patient also alleged that the attending staff had failed to respond to her concerns in a timely manner.
The patient was ultimately successful at trial and was awarded $177,836.41.
This case did not concern physical injury to the patient or her baby arising from the medication error. There was no evidence of physical harm beyond the symptoms associated with the magnesium sulphate infusion, nor any evidence that the baby sustained injury. Instead, the claim centred on the patient’s distress arising from those symptoms, her perception that her concerns were not adequately recognised or responded to by staff during the infusion, and the anxiety she experienced regarding her own safety and that of her baby. Once the medication error had been recognised, the patient received appropriate and timely medical review. Furthermore, blood tests showed that the patient’s magnesium levels remained in the therapeutic range at all times. The patient was subsequently diagnosed with Post Traumatic Stress Disorder, which she contended resulted from the medication error.
The Court’s decision was one of the first where the Court has expounded on section 5S of the Civil Liability Act 2002 (WA), which determines when a defendant has a duty of care to a plaintiff to prevent them from suffering mental harm.
While grounded in legal reasoning, the decision yields three takeaways that may inform clinical judgment and practice:
Patient experience can ground a claim even in the absence of physical harm.
A patient’s experience of a complication or error may give rise to a claim even in absence of any physical harm or adverse clinical outcome. Early, appropriate debriefing with patients can help them to understand what has occurred and ensures they feel heard and acknowledged. Although the patient was not ultimately successful in this aspect of her claim, she alleged that hospital staff failed to adequately reassure her that the medication error was unlikely to have harmed her baby. The patient was however successful in her claim that hospital staff had failed to respond to the patient’s concerns expressed during the infusion.
Good notetaking is key following a clinical incident.
Although the Court accepted that the patient received timely and appropriate medical review once the medication error had been identified, the brevity of the clinical notes documenting that review made it difficult for the defendant to demonstrate that appropriate reassurance had been provided regarding the likely impact of the error on the patient and her baby.
Adherence to protocols has legal as well as clinical significance.
Compliance with applicable protocols and procedures is more than just a matter of good clinical practice. In this case, the hospital protocol required specific observations to be taken during the course of the magnesium sulphate infusion. The failure to strictly comply with the requirements of the protocol gave the plaintiff an opportunity at trial to seek to undermine the competence and diligence of the treating staff.
