Health service fined after nurse bashed

Victim was alone with dangerous patient.

An assault on a mental health nurse at Morisset Hospital has cost the Hunter and New England Area Health Service a $105,000 fine.
Justice WR Haylen of the NSW Industrial Relations Commission imposed the fine for breaches of occupational health and safety law.

He said the area health service had pleaded guilty to ‘a quite comprehensive failure’ of safety systems.

The male nurse was working alone in the courtyard of Morisset’s Kestrel Unit when assaulted by a patient on 1 January 2001.
Hunter and New England Area Health admitted it did not maintain a system designed to ensure that the status of all patients in the Kestrel Unit was discussed at shift handovers.

Before starting his shift the nurse asked the surveillance officer about a new patient, referred to as ‘BF’, and was told there was no problem with him.

Yet according to his medical records BF had stabbed a staff member at Mandala Clinic in 1996. Before that he had been charged with resisting arrest and assaulting a police officer. He reported ‘hearing voices’ a few days before the assault on the nurse.

The courtyards at Morisset were where most aggressive incidents occurred, yet there was no formal policy or procedure requiring staff members not to enter courtyards on their own.

While preparing to serve afternoon tea to patients, the nurse noticed ‘BF’ banging on the nurses’ station door, yelling and swearing.

When BF started walking in the nurse’s direction, the surveillance officer watching via closed circuit TV, issued an alert on the PA system, calling for staff to help the nurse.

The nurse activated his duress alarm but BF punched and kicked him.

Observing the assault on CCTV, the surveillance officer issued a second alert over the PA.

Several nurses arrived to help about 60 seconds after the assault began.

The nurse was admitted to hospital briefly, had a total of 17 days off work, and appeared to have made a complete recovery, Justice Haylen said.

The hospital later adopted a policy of staff not entering the courtyard alone.

Justice Haylen said there was no effective system to monitor the operation of the duress alarm together with the public address and surveillance system.

There were undetected black spots in the operation of the system and staff were inadequately informed about potential danger from certain patients.

The area health service was aware of these deficiencies six months before the assault but did not rectify them in time.

Duress alarms were checked for defects once a week but there was no method of identifying low batteries in the interim, the system registered false alarms, and when defects were detected in the personal alarms they were sent for repair without replacements being made available.

Alarms and the security system were not regularly audited, in breach of the departmental manual.

Justice Haylen rejected the area health service’s argument ‘that in some way the requirements of these patients are such that staff must accept that they will be subjected to aggressive, assaultive behaviour with attendant injury’.

‘It is one thing to know of the existence of such behaviour and the likelihood it will occur from time to time but it is another matter to simply acquiesce in its occurrence,’ he said.

‘A civilised and humane society is obligated to strive to ensure that these two, often competing, objectives are secured.’
The full text of Justice Haylen’s decision can be viewed at: http://caselaw.lawlink.nsw.gov.au/isysquery/irlbfe1/1/doc

If in doubt – don’t work alone

The NSW Nurses Association is concerned about an increasing number of assaults on members, including by nursing home patients with dementia.

Common factors in these assaults are:

  • The victim was working alone
  • There was no accessible duress alarm, or it was inadequate or faulty.
  • Staff numbers and/or skill mix were inadequate.

We draw members’ attention to NSW Health guidelines, which recommend that nurses work in pairs or with a security officer when dealing with potentially dangerous patients.