Nurse awarded damages after incident involving patient in Emergency Department

In the recent Cairns District Court decision of Armstrong-Waters v State of Queensland [2020] QDC 66 Judge Morzone QC DCJ found that the employer had breached its duty of care to its employee Mr Armstrong-Waters, a 53 year old male registered nurse, who claimed damages for a psychiatric injury and minor physical injuries after an incident involving a patient in the Emergency Department (ED) of a regional public hospital.

Mr Armstrong-Waters 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. Mr Armstrong-Waters then spoke with his supervisors about the incident and was subsequently assisted by the employer’s OH&S team. 

Mr Armstrong-Waters alleged the employer 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 employer’s position was that:

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

The trial judge observed the case involved critical factual issues about what actually happened in the incident itself and the conversations between Mr Armstrong-Waters and the employer’s personnel who spoke to him afterwards.

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 Mr Armstrong-Waters and the patient by a wall mounted television.

The trial judge found the employer had adequately conducted ongoing reviews of incidents of aggressive behaviour in the ED, and had provided adequate security staffing in the ED area, but that:

• the employer failed to provide Mr Armstrong-Waters with refresher aggressive behaviour management training after Mr Armstrong-Waters’ 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, the expectation of staff conduct, the elevated risk where staff were aggressive and provocative, and appropriate communication and treatment of all patients; and
• the employer failed to identify suitably qualified personnel to fulfil the immediate post incident roles referred to in its guidelines.

In his judgment the trial judge commented that Mr Armstrong-Waters’ 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, or the CCTV footage. In discussing Mr Armstrong-Waters’ 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 by Mr Armstrong-Waters towards the patient.  

As far as post incident management was concerned, the trial judge acknowledged the immediate response by the Clinical Nurse Consultant but found that Mr Armstrong-Waters was disengaged and unreceptive due to post traumatic stress disorder, with his condition having crystallised within the 12 hour period before he spoke to the Nurse Unit Manager and, subsequently, OH&S personnel.

In this case the employer was confronted with a difficult situation involving an altercation between a staff member and a patient in a busy public hospital ED at about 8:30pm on a Sunday night. There were multiple issues to be immediately addressed including the welfare of both the patient and Mr Armstrong-Waters.  

The judgment 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 be able to appropriately and immediately respond when any such incident occurs. Whilst this employer had appropriately addressed many of these requirements, Mr Armstrong-Waters ultimately succeeded in his claim because of the lack of refresher aggressive behaviour management training and the inadequacy, according to the trial judge, of the initial response by his supervisors.