Wilson v Gold Coast Hospital and Health Service [2023] QSC 135
Background Facts
Ms Trinet Wilson (‘Plaintiff’) was a registered nurse and was employed at the Robina Hospital by the defendant, Gold Coast Hospital and Health Service (‘Defendant’). Many of the patients on the Plaintiff’s ward suffered from dementia or delirium and would often be difficult or disruptive and would lash out aggressively at the nurses on the ward.
On the 12 March 2016, the Plaintiff was dealing with a patient with dementia who was being quite dangerous, aggressive, and resistant to her medication. In order to effectively calm the patient, the Plaintiff called two security officers to help restrain her and administer her with an intra-muscular injection that would relax her. Together with Ms Wilson, the security guards restrained the patient on her bed while another nurse administered the medication through a thigh injection. While restraining the patient, the two security guards held one arm of the patient each, while Ms Wilson held onto both of the patients legs.
As Ms Wilson was holding onto the patients legs, she was kicking and thrashing about quite recklessly causing the plaintiff to bend right over the base of the bed and put her hands around the patients ankles so she would not move while the other nurse injected the patients thigh. After the injection was given, the plaintiff and the security guards let go of the patient at the same time. As Ms Wilson released the patients legs, the patient quickly jolted and kicked her feet towards Ms Wilson which almost connected with her face. In order to avoid getting kicked, Ms Wilson quickly twisted her back which caused her some discomfort.
Shortly after this event Ms Wilson was attending with another patient, and as she squatted to flush another patient’s cannular, she felt a jolt of severe pain which radiated from her right sacroiliac through to her groin. Despite this pain, the Claimant managed to complete her shift before going home and taking some Valium.
Treatment and Rehabilitation
A few weeks after the incident, the Plaintiff saw Dr Neil Cleaver, Orthopaedic Surgeon for a follow up consultation who suggested there was an issue with her sacroiliac joints. In an effort to ease her pain, the plaintiff tried physiotherapy, hydrotherapy, a sacroiliac belt, Pilates, acupuncture, yoga, a TENS machine, hot and cold gel packs and attendance at a pain clinic for cortisone injections.
On 12 June 2017, the Claimant underwent fusion surgery to stabilise her sacroiliac joint to increase her movement and minimise her instability. While she was relieved of some pain for 3-4 weeks, the Claimant’s back pain soon returned and persisted.
Issue
The key legal questions from this case revolve around whether the defendant breached their duty of care to the plaintiff. This includes examining whether the defendant failed to instruct the plaintiff not to participate in patient restraint and whether the two security officers breached their duty by not calling for a third officer once they realized the patient required control.
Legal Context
In order to have a successful claim, Ms Wilson had to satisfy that her employer breached section 305B of the Workers Compensation and Rehabilitation Act 2003 (Qld). This re-iterates that:
1) A person does not breach a duty to take precautions against a risk of injury to a worker unless –
- The risk was foreseeable (that is, it is a risk of which the person knew or ought reasonably to have known); and
- The risk was not insignificant; and
- In the circumstances, a reasonable person in the position of the person would have taken the precautions
2) In deciding whether a reasonable person would have taken precautions against a risk of injury, the court is to consider the following (among other relevant things) –
- The probability that the injury would occur if care were not taken.
- The likely seriousness of the injury.
- The burden of taking precautions to avoid the risk of injury
Application to the Facts
As such, in this matter, Gold Coast Hospital and Health Service owed Ms Wilson a duty to take the precautions a reasonable hospital would have taken against the risk of injury to the plaintiff which was foreseeable and not insignificant.
The risk was foreseeable
Here, the patient Ms Wilson was seeing had cognitive vulnerabilities and had a history of aggression towards the nursing staff and others. The defendant was also aware that the patient was becoming progressively more difficult in the lead up to the incident as revealed in the hospital notes about her. Furthermore, other documented behaviours of the patient that the Defendant was aware of included:
- Three security officers had responded to Code Black calls relating to the patients behaviour more than once in the days before the subject incident;
- The patient had been aggressive towards her partner in March and hit him in the head for no reason;
- She had previously lunged at and attempted to choke another nurse;
- She had to be restrained on her bed for medication to be administered; and
- She could become agitated without a trigger.
Based on these circumstances, Justice Ryan of the Supreme Court found that the patient posed a foreseeable risk of physical injury to the plaintiff generally and in the course of being restrained.
The risk was not insignificant
Justice Ryan found that while the patient was a petite women and was restrained by two male security officers, she obviously had the physical capacity to lunge at or assault others and thereby cause harm. The patient’s history of acting out physically and with an intention to harm with whatever means necessary meant that she would pose a significant risk to anyone close enough to being hit, even if she was restrained.
Reasonable Precautions by a person in that circumstance
In relation to this area of contention, Justice Ryan found that a reasonable hospital and health service would take reasonably practical precautions to minimise the risk that clinical staff were not injured by patients like the one Ms Wilson was attacked by. He went on by stating that while the Gold Coast Hospital and Health Service did have various policies and procedures in place to minimise these risks, there was no clear division between the role of the security guards and the role of the clinicians and as such the Plaintiff still suffered injury.
Breach of Duty and Causation
Justice Ryan concluded by stating that, if the plaintiff had not been involved in the physical restraint of the patient – either because the security officers called for back-up, or because she was trained that the patient’s restraint was to be undertaken by security officers only – she probably would not have been injured by on 12 March 2016.
Quantum
One of the main areas of contention with this matter involved the injuries the Plaintiff sustained and whether her pre-existing complaints reduced her quantum. As such, based on the Plaintiff’s pre-existing degenerative condition she had, the Supreme Court made the following assessment of damages:
- General Damages – $25,150.00
- Past Special Damages/Expenses – $78,556.00
- Past Economic Loss – $473,548.16
- Interest on Past Economic Loss – $50,926.00
- Past Superannuation loss – $60,377.39
- Future Economic Loss – $800,000.00
- Future Superannuation – $95,040.00
- Fox v Wood Damages – $21,821.00
- Future Special Damages/Expenses – $29,000
This equated to a total of $1,634,418.55 in damages being awarded to Ms Wilson.
Takeaway
This case highlights the importance of understanding the standard of care and duty of care within healthcare institutions. It also underscores the significance of appropriate training and communication to ensure healthcare professionals’ and patients’ safety and well-being.