Nurse awarded damages after patient barges through a door

Ringuet v State of Queensland [2019] QDC 91

Muir DCJ

6 June 2019

Background

The Plaintiff was a nurse who sustained injuries to her back together with a secondary psychological injury, after a patient attempted to barge through a door in the nurses' station in the Psychiatric Intensive Care Unit (the PICU) on 9 August 2012.

Liability

Liability was in dispute.

The Plaintiff argued the PICU was poorly designed, more staff ought to have been present to keep an eye on a patient before a nurse entered the PICU, including either a male nurse or a security guard, the patient ought to have been placed in seclusion, more convex mirrors ought to have been installed or in the alternative, CCTV monitors installed.

The Defendant argued the patient rushing to the door was an opportunistic and spontaneous event and any of the steps suggested by the Plaintiff would not have avoided the incident from occurring and were not reasonable.

Judgement/findings

Her Honour found:

• The risk of the patient trying to abscond from the PICU causing injury to a nurse along the way was obvious and reasonably foreseeable. Such a risk was well known to the Defendant. Given the patient's history of behaviour known to the Defendant it was not an insignificant risk. It follows that the risk that a nurse might sustain an injury trying to prevent a patient from escaping a secured area of the PICU as the PICU door was being opened was foreseeable and not insignificant;
• There was no breach of duty by the Defendant for failing to generally provide guidelines or protocols or risk assessments;
• Having a sign on the door asking the patient to stand clear of the door would not have made any difference;
• It was not a reasonable, practical or necessary precaution for the Defendant to have implemented a system that the nurses on duty in the PICU were to be the eyes and ears of each other to the extent agitated by the Plaintiff such that one would need to be at the nurses station to watch the other as they entered in and out of the PICU through the PICU door;
• It was not a reasonable or practical precaution for the Defendant to have insisted that a male nurse be on duty when a patient was admitted to the PICU nor was she satisfied that it was reasonable or practical for the Plaintiff not enter the PICU at any time without a strong male nurse being present;
• The Defendant ought to have implemented a system in which a security officer was to be called to attend the PICU to assist nursing staff to make safe access to the unit on the occasions where at the time the nurse needed enter the PICU, the patient was observed (whether in a calm or agitated state) to be in the communal area of the PICU. The system did not require a security officer to be called every time a nurse went into the PICU, only when the patient was observed to be within the vicinity of the PICU door in the communal area, an area obviously close enough to the PICU door for the patient to be able to make a run for it;
• The issue of a chrome ball was a distraction. She was not satisfied its use would have averted the incident. If the Plaintiff had viewed the chrome ball by standing back from the PICU door, she would not have seen anything outside the PICU door. It was highly unlikely the Plaintiff would have seen the patient charge at the door as he did;
• There was no evidence to support the Plaintiff's submission that at the relevant time the patient ought to have been in the seclusion room. She was not satisfied placing the patient in seclusion was a reasonable precaution to an assessment that he was at a high risk of absconding and aggression. This was particularly so in circumstances where there was no evidence that he was acting out or aggressive from the start of the Plaintiff's shift;
• It was not a reasonable measure for a second convex mirror or other mirror to be placed opposite the nurses door so observations could be made through the glass window in the PICU as the Plaintiff would not have seen the patient charge at the PICU door as he did;
• Installation of CCTV monitor would not have averted the incident and the Defendant failing to implement such a system was not a breach of its duty.

Damages were assessed at $326,312.75 plus costs.

Discussion

The finding regarding the use of a security guard places an onerous responsibility on an employer who may be responsible for looking after high risk patients, to have available security guards to assist nurses enter certain parts of units, even if a patient does not display any concerning behaviours, but has a history of attempting to abscond.