Nurse awarded damages after patient incident

Armstrong-Waters v State of Queensland [2020] QDC 66

Morzone QC DCJ – Cairns District Court

Delivered on 24 April 2020

Background

The Plaintiff, a 53 year old male registered nurse, claimed damages for a psychiatric injury and minor physical injuries after an incident in the Emergency Department of a regional public hospital on 19 January 2014.

The Plaintiff alleged that after he removed a blanket from a male patient who was lying across seats in the ED waiting room, the patient assaulted him, leading to a scuffle on the floor until the Plaintiff forcibly removed him from the waiting room. The Plaintiff then spoke with the Clinical Nurse/Team Leader and the Clinical Nurse Consultant about the incident, met with the Acting Nurse Unit Manager the following morning, and was subsequently assisted by the employer's OH&S team.

The Plaintiff did not return to paid employment.

Liability

The trial judge observed the case involved critical factual issues about the incident itself, the subsequent conversations between the Plaintiff and the Defendant's employees, and the resultant injuries.

The waiting room CCTV footage was of key relevance but was limited to some extent by the lack of audio recording and a brief obstruction of the view of the interaction between the Plaintiff and the patient by a wall mounted television.

The Plaintiff alleged the Defendant breached its duty of care to him by:

• failing to conduct adequate reviews of incidents of aggression in the ED and take adequate steps to eliminate or reduce the risk;
• failing to provide regular training on how to manage aggressive behaviour;
• failing to provide an adequate number of security staff in the ED; and
• failing to provide an adequate post incident response.

The Defendant contended that:

• the Plaintiff failed to prove any breach of duty (as well as causation) in circumstances where the Plaintiff provoked any assault by roughly removing blankets from the sleeping intoxicated patient;
• there was no alternative system which could have been put in place to prevent such an incident from occurring; and
• the Plaintiff subsequently received support from multiple appropriate employees of the Defendant, regarding his fitness to continue working and the treatment/assistance available to him.

Judgement/findings

As to liability, the trial judge found that:

• the Defendant failed to provide the Plaintiff with refresher aggressive behaviour management training after the Plaintiff's initial four day training program some years earlier;
• timely refresher training would have reduced the probability of assault by addressing the triggers and warning signs of patient aggression, expectation of staff conduct, elevated risk where staff are aggressive and provocative, and appropriate communication and treatment of all patients; and
• the Defendant failed to identify suitably qualified personnel to fulfil the immediate post incident roles referred to in its guidelines.

The trial judge found that the Defendant had adequately conducted ongoing reviews of incidents of aggressive behaviour and that there was adequate security staffing in the ED area.

In his judgement the trial judge commented that the Plaintiff's historical recollection of the incident was unreliable and his evidence about the incident was not accepted except where it was consistent with the evidence of other witnesses, contemporaneous notes, and the CCTV footage. In discussing the Plaintiff's behaviour towards the patient, which he described as disdainful and hostile, the trial judge concluded that prior refresher training would have resulted in different behaviour towards the patient.

As far as post incident management was concerned, the trial judge acknowledged the immediate engagement of the Plaintiff by the Clinical Nurse Consultant, who recommended medical review at triage and consultation with the Nurse Unit Manager the following morning, but found that the Plaintiff was disengaged and not receptive due to post traumatic stress disorder. He concluded the Plaintiff's condition had crystallised within the 12 hour period before he spoke to the Nurse Unit Manager and, subsequently, OH&S personnel.

In assessing damages, the trial judge did not allow any uplift for the physical injuries which were minor.

Although the Plaintiff had not returned to any paid employment, past economic loss was allowed on a graduated basis reflecting an increase in potential earning capacity during the period between the incident and the trial.

An award of $100,000.00 was made for future economic loss reflecting a one third diminution in earning capacity to age 67 discounted by 20%.
Judgement was entered for the Plaintiff in the sum of $357,073.49.

Discussion/implications

The Defendant was confronted with a difficult situation involving an altercation between a staff member and a patient in a busy public hospital Emergency Department at about 8:30pm on a Sunday night. There were multiple issues to be immediately addressed including the welfare of both the patient and the Plaintiff.

The judgement highlights the need for employers in this type of environment to have detailed procedures in place to both identify and reduce the risk of such incidents and to appropriately respond when any such incident occurs. Whilst the Defendant had appropriately addressed many of these requirements, the Plaintiff ultimately succeeded in his claim because of the lack of refresher aggressive behaviour management training and the perceived inadequacy of the initial response to the Plaintiff.