Triage and Investigation of Shoulder Injury

Deputy Health and Disability Commissioner Kevin Allan today released a report finding the Department of Corrections and a doctor in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in health care provided to a man in prison.

Following a fall the man asked to be seen by a doctor for shoulder pain. The man saw the doctor about nine weeks after this request was made. In the interim he made three further health requests and saw Corrections nurses on four occasions. The nurses triaged his requests and prescribed arnica cream, Panadol and brufen.

The doctor diagnosed him with a soft tissue injury and did not consider an x-ray was indicated. The doctor gave him a steroid injection.

The man continued to experience shoulder pain and made two further requests to access health services before he was seen by a second doctor. That doctor diagnosed an infection and prescribed an antibiotic.

Two days later the man was admitted to the emergency department at a hospital where he was diagnosed with a soft tissue abscess following an x-ray and ultrasound.

The first doctor was found to have breached the Code for failing to undertake appropriate investigations, in particular an X-ray, for the purpose of forming an appropriate diagnosis, for administering a cortisone injection without excluding a fracture, and for not documenting his assessments, clinical decision-making process, or any diagnosis. As a result the second doctor had little information available to him.

Kevin Allan said a person being held in custody does not have the same choices or ability to access health services as a person living in the community.

"They do not have direct access to a GP, and are entirely reliant on staff at the Health Centre to assess, evaluate, monitor, and treat them appropriately."

All of the nurses who saw the man failed to adhere to Corrections’ triage policy in some way and many were unaware that a triage scoring system was required. The doctors who saw the man failed to assess and investigate his injuries adequately. Ultimately Corrections was responsible for the care provided to the man and was found in breach of the Code.

In response to a recommendation made by Kevin Allan, Corrections and the doctor have apologised to the man. Mr Allan also made recommendations to Corrections regarding training nursing staff, updates to their operation manual and triage scale guide, documentation and staff compliance and effectiveness of the triage process.

The full report for case 16HDC00776 is available on the HDC website.

ENDS

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