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Injured QLD Nurse - Awarded $1.6M in Damages

By Ji Burton

A Queensland Nurse badly injured during a patient restraint gone wrong has been awarded $1.6M in Damages for Robina Hospital’s failure to provide adequate Hospital Security.

Justice Ryan of the Supreme Court of Brisbane handed down their Decision on 23 June 2023 in the matter of Trinet Ruth Wilson v Gold Coast Hospital and Health Service [2023] QSC 135 finding Gold Coast Hospital and Health Service liable to pay $1,634,418.55 to a Registered Nurse badly injured during a shift on 12 March 2016 at the Robina Hospital.  

Key points from Justice Ryan in reaching their Decision, as follows:- 

Wilson was a Registered Nurse aged 39 at the time of her injury [1, 12].

She was involved in the restraint of a patient with dementia, who had been difficult, disruptive, acting out physically and refusing medication [1].

Security Guards were called to assist in administering the patient’s anti-psychotic medication [42].

Two Security Guards (instead of three) arrived to assist with restraining the patient [45].

The Security Guards marched/dragged the patient back to her room. She was elevated and resisting [46]. 

The Security Guards restrained one arm each. The patient’s legs were flying, kicking and thrashing about [47]. 

Nurse Wilson was over the base of the patient’s bed, placed her hands around the patient’s ankles, pushed them to keep them straight so that she would not move while another Nurse injected her thigh [48].   

After the injection was given, Nurse Wilson made sure her colleague administering the injection was out of the way, Nurse Wilson and the Security Guards all let go at the same time. As Nurse Wilson let go of the patient’s legs “both feet, like, nearly connect with my face and I’ve managed to, like, come from this position and I arched back really quick and I felt her feet. And then I noticed she had thrown like, her arm movement, like she was throwing something, so I’ve twisted – so I’ve gone and then twisted… I felt uncomfortable. I was uncomfortable. There was discomfort” [50].  

To her credit, Wilson attempted to return to work the day after the incident, as it was a Sunday and penalty rates applied. She commenced her shift at 8:00 am, made it through the “safety scrum”, made it to the second or third medication rounds, and then, as she went to unlock a drawer with a key at head height, she became stuck in position. Her evidence at Trial was “it happened again”; “out of nowhere”. She returned to the Nurse’s station to sit down. She could not recall whether she completed the remainder of that shift.  

Wilson called in sick Monday and had a further three (3) days scheduled off before returning to work the Friday with a lighter patient load. She persevered through a couple of shifts but found she was continuing to experience spasms, whether she stood or sat still. Squatting down at the Nurse’s station eased her pain.  

She again attempted to work the following Sunday (Easter Sunday). She experienced another spasm when picking up a folder from a desk. She lay in an empty Hospital bed.  

Some months passed and Wilson attempted to work again in July 2016, within her suitable duties program (being short shifts, three (3) times a week). Wilson did not perform any tasks on those shifts other than making patients cups of tea and continued to suffer spasms.  

The state of the Ward at the time of the incident  

On 12 March 2016, Wilson was rostered to work from 1:00 pm to 9:30 pm at the Robina Hospital’s Specialised Medical Unit (SMU), a 24-bed medical ward with a “mixed bag” of patients. The SMU was a busy ward, requiring heavy work. Most of the patients in the SMU were over 65/70 years of age, which included those transferred from nursing homes with medical problems. Often, those patients suffered from dementia or delirium.  

During the pre-start or “safety scrum” of Nurses at the beginning of the shift, Wilson was told that the patient who later injured her had “a couple of Code Blacks previously and had been quite aggressive to other nurses”. The patient had previously grabbed her at-home care Nurse by the throat and kicked and scratched her.  

The staff skill mix for the shift on 12 March 2016 was, in the evidence of Wilson, “really bad” and included two new Graduate Nurses (in their second month), a pregnant Enrolled Nurse, a Clinical Nurse and one other Registered Nurse. Wilson was not allocated to the patient who later caused her injuries. A new graduate Nurse was assigned to the patient, who became overwhelmed. There were also three (3) to four (4) other patients who also suffered dementia in the Ward and had been wandering “non-stop” throughout the Ward.  

The patient who later caused Wilson’s injury had been being difficult, and disruptive, attempting to break into other patients’ rooms, acting out physically and refusing medication. Security Guards were called to assist in administering the patient’s anti-psychotic medication.  

In making a Judgment as to the factual findings of the workplace incident, Justice Ryan declared: 

  • [283] I find that in 2016, the patient mix on the SMU included an increasing proportion of older patients with “behaviours” as a consequence of their dementia or other cognitive vulnerabilities, which manifested in confusion, disruption, wandering, verbal abuse, physical aggression and assault. 
  • [284] I find that the staff on the SMU were not trained to deal with those patients, as the defendant acknowledged in the 2016 OVRAT, beyond being told to prioritise their own safety via the “ICE” approach – isolate, contain and evacuate.  
  • [289] I find that “M” (the patient) did not settle upon the arrival of the two security officers on the ward. They had to drag her or march her back to her room. She was not subdued by their mere presence as she demonstrated by her resistance in the face of it; her conduct whilst on the bed; and the urgency around the need to administer medication to her so that she might calm down. 
  • [294] I find (indeed, the parties essentially agreed) that the plaintiff did not receive training in how to (safely or at all) restrain a patient – either from the point of view of her participating in restraint or being able to evaluate whether a restraint executed by security officers (or other relevant trained staff) was being safely executed. Nor was the plaintiff instructed not to participate in the restraint of a patient, but to leave that to security officers (other than, obviously in circumstances in which the plaintiff was entitled to defend herself).  

Justice Ryan found that the patient “M” who injured Wilson posed a foreseeable risk of injury to Wilson generally and in the course of being restrained. Gold Coast Hospital and Health Service tried to argue the risk posed by this patient to Wilson was insignificant. Justice Ryan found the risk was not insignificant.  

Justice Ryan found Robina Hospital negligent on the following grounds:- 

  1. The Defendant was negligent in failing to instruct Nurse Wilson not to be involved in the physical restraint of a patient [5]; and  
  2. Additionally, …the Defendant was negligent because of the failure of two security officers who attended the ward to call for a third to take part in the restraint, rather than the plaintiff. Had the security officers called for a third to take part in the restraint, then, for the same reasons as above, Nurse Wilson would not have been injured.  
The injuries and impact on employment  

The Plaintiff underwent significant treatment, including:- 

  • Treatment by Dr Cleaver (Spinal Orthopedic Surgeon);  
  • Cortisone injections (which gave her about nine (9) days of relief);  
  • Physiotherapy;  
  • Hydrotherapy;  
  • Sacroiliac belt;  
  • Pilates;  
  • Acupuncture;  
  • Yoga;  
  • TENS machine; 
  • Hot and cold gel packs;  
  • Treatment with a Pain Clinic;  
  • Right-sided sacroiliac joint fusion (which she funded herself). 

Following fusion surgery, Wilson (after a five (5) day hospital stay and an inability to weight bear for a few weeks) was free of spasms and pain for three (3) to four (4) weeks before sadly experiencing “out of nowhere” that the dragging sensation in her groin had returned, followed by spasm. “Things were back to how they had been”.  

Wilson describes experiencing deep aching in her right sacroiliac joint, a dragging sensation in her groin, numbness, and spasms occurring five to twenty times per day with those symptoms relieved by crouching, curling and squatting. The pain is mostly in her pelvis and hip. The aching (in the right sacroiliac joint) and dragging sensation (in the groin) are constant. There is also numbness in the joint. 

The Court found she is now in a worse state than she was in 2016 because she has de-conditioned.  

Wilson now walks with a limp, has gained thirty kilograms and pain medications make her drowsy. Her mental health has deteriorated.  

At the time of the Trial, she was receiving a Disability Support Pension and Family Tax Benefit ($750.00 a week). Her rent, per week, was $550.00 a week.  

Future intentions  

Wilson’s intention was to work as a Clinical Nurse, in the SMU for as long as possible “til I drop, pretty much”.  

Pre-existing conditions  

It was of great debate throughout the Trial as to what impact, if any, Wilson’s earlier fusion surgery prior to the incident in 2015 for correction of a degenerative process had on her current state. It was not contested that Wilson had widespread degenerative pathology in her sacroiliac joint. However, Justice Ryan opined “That did not mean that she inevitably would have become symptomatic (even if she had not been injured at work in March 2016), but I find that there was a degree of probability that her degeneration would progress to the point at which she was symptomatic”. Despite her prior surgery and condition, Damages were assessed as follows: - 

  • General Damages - $25,150.00  
  • Past Economic Loss - $473,548.16 with interest of $50,926.00 
  • Past Superannuation Loss - $60,377.39  
  • Future Economic Loss - $800,000.00  
  • Future Superannuation - $95,040.00  
  • Past Expenses - $78,556  
  • Future medicals - $15,000 
  • Future travel expenses - $2,000 
  • Future pharmaceuticals - $12,000 
  • Fox -v- Wood damages - $21,821 

In determining Future Economic Loss, the Defendant argued the Nurse only had a further twenty (20) years residual earning capacity due to her pre-existing degenerative condition, and, that this was to be further discounted by 50% for contingencies, including the hypothetical event that the plaintiff in any event would have suffered a similar disabling back condition. Wilson, however, invited that the more usual reduction of 10% for contingencies only be made, and no further discounting was appropriate.  

Justice Ryan reached the award for Future Economic Loss by “starting at the scenario proposed by the plaintiff but discounting it (by 50%) for contingencies including, but not only, the contingency that she might not work a 40-hour week plus Sunday and weekend shifts from 2019 until she was 67; and the contingency that she might, in the future, suffer from pain symptoms because of pre-existing degeneration and/or the consequences of her prior surgery which might shorten her working life.”  

The Plaintiff was awarded Damages of $1,634,418.55.  

The full Judgment from the Queensland Supreme Court can be found here