Damages for nurse injured by escaping patient

In April 2020, the Queensland Court of Appeal handed down its decision in State of Queensland v Ringuet[1].

The facts of the case were essentially as follows:

• On 9 August 2012, Ms Ringuet was working as a Nurse in the Acute Young Adult Mental Health Unit at Robina Hospital.
• Within that unit, there was a secure area called the Psychiatric Intensive Care Unit (‘the PICU’).
• As Ms Ringuet opened the door to the PICU, a young male patient attempted to escape. Ms Ringuet managed to push back against the door to prevent his escape, but in doing so sustained a back injury and secondary psychological injury.
• Ms Ringuet initially succeeded in her claim in the District Court, being awarded Judgement in the sum of $326,312.75.
• The trial Judge found that the State of Queensland was negligent by failing to provide a system of work under which, if there was a prospect that a patient would attempt such an escape from the PICU because the patient was then in the vicinity of the door in a certain area in the PICU, a nurse in Ms Ringuet’s position could call for the assistance of a security officer as he/she was about to open the door.[2]
• The State of Queensland appealed the trial Judges’ findings.

The findings of fact made by the District Court trial Judge were not in dispute on appeal. The findings of fact were:

1. 1. From the nurses station, Ms Ringuet observed this patient as he sat calmly on a bench in the communal area of the PICU at about 10am;
   2. The distance from where he was sitting to the door was approximately 15 metres;
   3. From the nurses station, Ms Ringuet walked to the door, intending to enter the PICU to perform the task of clearing rubbish from there;
   4. She looked through the small rectangular glass panel within the door as she opened it;
   5. In the period of approximately 4 seconds from when he was seen by Ms Ringuet, sitting on a bench in the communal area, the patient ran across the communal area to the door, and attempted to push through as soon as Ms Ringuet had turned the handle from the open side;
   6. Using all of her strength through her hands and shoulders, Ms Ringuet managed to push the door back and immediately called out for help;
   7. She called for help twice, and on the second occasion two nurses rushed to her assistance from the open side, placing their hands against the door and, for a few seconds, trapping Ms Ringuet between them and the door as they did so;
   8. After no longer than about 40 seconds, Ms Ringuet was able to manoeuvre herself away from the door, allowing those nurses to take over the struggle with the patient who was subsequently subdued.[3]

Importantly, in the days preceding the incident, the patient had absconded twice from the hospital, was returned to the hospital by his family, and attempted to abscond on a third occasion.

There were a number of issues argued on appeal by the State of Queensland, but most strongly argued was that the determination of the trial Judge that a safe system of work required a system whereby a person in Ms Ringuet’s position could call for assistance of a security officer as he/she was about to open the door was not:

1. 1. Reasonable in all the circumstances including costs etc;
   2. Would involve a difficulty in instructing staff as to what was expected of them and making such a judgement call in differing circumstances;
   3. Was practically difficult in that the patients movements may alter and render assistance by security as unnecessary;
   4. There was no evidence as to the burden such a system would place upon security staff;
   5. There would be no deterrence to patients as they would not know of the existence of the security officer until the door was open.

These arguments were rejected by the Court of Appeal and it was unanimously found that:

• The evidence supported a finding that there would have been a benefit from this system, which was relevant to, without itself proving, a finding that the system should have been provided;
• The evidence established that a reasonable person in the position of the State of Queensland would have taken this precaution;
• The system was likely to have been beneficial in avoiding or minimising the relevant risk, and on the evidence it was unlikely to have been problematic or prohibitively expensive in its operation.

The appeal was dismissed with costs.

The decision gives important direction to employers as to the systems that should be in place to protect their staff whom are working in riskier settings, particularly in the health care field. Importantly, for nurses, disability support workers and the like, the decision provides assistance in establishing a breach of the duty of care where reasonable steps are not taken by the employer to guard against known risks presented by challenging patients.

[1] [2020] QCA 61

[2] Ringuet v State of Queensland [2019] QDC 91 at 194

[3] QCA Reasons at 10