Nurse injured; security (and explicit instruction) needed

19 July 2023

A hospital was found to have breached a duty to take precaution against a foreseeable risk of injury when a nurse suffered an injury while assisting security with the restraining of an aggressive patient.

In issue

  • Whether the defendant employer had breached its duty to take precautions against a foreseeable risk of injury to the plaintiff.
  • The extent the plaintiff’s pre-existing back conditions would have interfered with her ability to work in the absence of any injury sustained in the incident.

The background

The plaintiff, a registered nurse, injured her sacroiliac joint at work when assisting another registered nurse and two security guards in the restraint of an aggressive patient with dementia. The guards were positioned on each side of the patient, restraining her arms. The plaintiff was standing at the base of the bed, holding the patient’s legs, while her co-worker administered a sedative. Following administering the sedative, and without warning, the guards and the co-worker released the patient, who in turn kicked out her legs in the direction of the plaintiff. The plaintiff abruptly twisted her body and pulled away in response. Later in her shift, the plaintiff squatted down and felt immense pain in the region of her right sacroiliac joint.

The plaintiff’s attempts to return to her employment were unsuccessful on account of her ongoing pain. At the time of trial, she was receiving a disability support pension and was relying on her superannuation benefits.

Relevantly, the plaintiff had a significant history of pre-existing spinal issues for which she underwent spinal fusion surgery in the year preceding the incident. Investigations following the incident also revealed pre-existing, though asymptomatic, degenerative sacroiliac joint pathology.

The plaintiff submitted the circumstances prior to the incident were that of an emergency and that the defendant did not respond appropriately to a Code Black call. Accordingly, the plaintiff argued the defendant employer ought to be held liable for her injuries on account of:

  • Its failure to respond appropriately to the Code Black which was called;
  • Its failure to respond adequately, whether a Code Black was called or not;
  • The failure of the security officers to call for 'back up';
  • The way in which the patient was released from restraint;
  • The failure to adequately train the plaintiff in the physical restraint of patients.

The defendant in turn submitted, in effect, that the likely seriousness of any risk of injury posed by the patient was relatively low and that accordingly, a reasonable hospital and health service would not have taken any other precautions to protect the plaintiff from it.

The decision at trial

Ryan J accepted the defendant’s contention that a call was made to security for assistance with the patient rather than a Code Black call. However, having regard to the defendant’s procedures, Her Honour found that the security guards should have then called for one or more extra guards to assist the restraint of the patient.

Her Honour found, based on the patient’s past behaviour, the risk posed by the patient was not insignificant while she was on the bed with the security restraining her arms. Ryan J considered it reasonably practicable for the plaintiff to have been explicitly trained to leave the restraint of a patient to security officers, as consistent with the defendant’s relevant procedures.

Ultimately, Her Honour found the defendant employer had breached its duty of care because of:

  • Its failure to train the plaintiff not to be involved in the physical restraint of the patient, other than as a last resort; and
  • The failure of the two security guards who attended the patient to call for a third security guard to take part in the restraint, rather than the plaintiff.

In assessing quantum, Her Honour proceeded on the basis that while there was a risk of the plaintiff developing sacroiliac joint symptoms but for the incident, the development of symptoms preventing the plaintiff from working at all was not likely to have occurred by the time of trial, although acknowledged there was a small risk of that occurring.

Her Honour accepted the plaintiff did not retain any residual earning capacity, however, discounted the award for future economic loss by 50% based on the vicissitudes of life, the contingency that the plaintiff might not have worked full-time with penalty shifts every year of her working life, her demands as a mother, and because of the pre-existing conditions.

Implications for you

This matter demonstrates the importance of employers implementing explicit instruction and training that is consistent with its own procedures. Had the plaintiff in this circumstance been properly instructed to refrain from assisting security in restraining patients, other than as a last resort, as consistent with the employer’s procedures, it is likely that no injury would have been suffered.

Trinet Ruth Wilson v Gold Coast Hospital and Health Service [2023] QSC 135

Ask us how we can help

Receive our latest news, insights and events
Barry Nilsson acknowledges the traditional owners of the land on which we conduct our business, and pays respect to their Elders past, present and emerging.
Liability limited by a scheme approved under Professional Standards Legislation