On 6 June 2019, the District Court of Queensland determined that a nurse's employer had breached its duty of care. The nurse had suffered physical and psychological injuries after a mental health patient tried to escape by barging through a door as she tried to open it.
The Court concluded that there ought to have been a system in place whereby security guards would attend the unit so as to assist nurses in having safe access.
The plaintiff was employed by the defendant as a registered nurse in an acute young adult mental health unit. On 9 August 2012, the plaintiff left the nurses' station to walk into the locked Psychiatric Intensive Care Unit (PICU). Upon opening the PICU door, a young male patient attempted to push his way out through the door. To prevent the escape, the nurse pushed against the door. She called out for help, being unable to activate her personal duress alarm because her hands were occupied. She contends that the incident resulted in her suffering an injury to her lumbar spine and consequential psychiatric injury which left her unable to work full time and necessitated her re-training as a psychologist.
The plaintiff alleged that her employer was negligent and breached its duty of care to her, in failing to take a number of steps that it allegedly ought to have taken: These included that:
The defendant contended that:
The plaintiff was noted to have played down her knowledge of any written guidelines and instructions. Staff were told how to use the convex mirror on orientation. However, Muir DCJ accepted the nurse’s evidence that it was not her practice to use the chrome ball because it gave a distorted view and also that there was no formal instruction that the ball must be used before entering the locked area of the PICU. It followed that there was no consistent system or policy in place about the use of the mirror and the plaintiff should not be criticised for not using it.
In relation to the incident which prompted a risk assessment of the patient to be conducted, there was little evidence about the extent to which a handover occurred. Her Honour accepted evidence that the nurse was not told of the risk assessment conducted that morning. She made a judgment call that it was appropriate to enter the PICU. Her Honour found that it was a reasonable one, made in conformity with the PICU Management Guidelines, practices and policies.
The nurse’s employer owed a non-delegable duty to take reasonable care to avoid exposing employees to unnecessary risks of injury. In considering whether a reasonable person would have foreseen the risk of injury, it was uncontroversial that the defendant knew that the patient had significant mental health issues including schizophrenia, had violent outbursts every few days, had assaulted his mother while she visited him at the hospital and suffered from auditory hallucinations which included voices advising him to kill the nursing staff. The risk of the patient trying to abscond and causing injury to a nurse in the process was reasonably foreseeable.
Her Honour found that the defendant was not liable for failing to provide guidelines, protocols or risk assessments, for failing to instruct the nurse to ask patients to back away from the door, for not putting the patient in the seclusion room, for failing to require use of the convex mirror or for not providing a second mirror to assist. Arguments that there ought to have been CCTV in use to observe the patients was rejected. It was not therapeutically in the interests of patients or staff, was nor reasonable or practical, and was not a relevant response given how quickly the incident occurred.
It was similarly not a reasonable, practical or a necessary precaution for the defendant to have ensured that the nurses be 'the eyes and ears of each other' or to roster a male nurse on for every shift, as the plaintiff had suggested. In any event, her Honour was not satisfied that these steps would have avoided the incident.
Her Honour determined that the defendant did breach its duty in failing to implement a system whereby a security officer would be called to attend the PICU when the nurse needed safe access and a patient was in the vicinity of the door. Given that security officers were employed and present at the hospital, it would not be too impractical to implement such an arrangement, notwithstanding that it might necessitate the nursing staff waiting a few minutes to enter the PICU on occasions. Implementation of this would have avoided the incident.
In considering quantum, Her Honour found that the physical injury suffered as a result of the incident was an ongoing muscle-ligamentous strain to the lumbar spine. In light of the plaintiff's tendency to exaggerate her pain, her Honour concluded that evidence of a 7% whole person impairment led by the plaintiff should have been slightly lower. As regards her mental health, her Honour found that as a result of the incident, the plaintiff is not suited to work as a nurse in an acute mental health setting. It was therefore reasonable and appropriate for the plaintiff to have pursued another career as a psychologist as result of the incident. Her Honour rejected the defendant’s argument that she is able to work full time.
General damages were awarded for pain, suffering and loss of amenities of life and for past and future economic loss. Special damages were awarded for medical treatment and future expenses were included. Judgment for the plaintiff was awarded for the total sum of $326,312.75.