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Unreasonable Restraint Of Patient In Secure Unit

Deputy Health and Disability Commissioner Rose Wall today released a report finding a nurse in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for his care of a man residing in a secure facility.

The man, aged in his fifties at the time of these events, has an intellectual disability and physical health concerns. He resides in a secure facility operated by the DHB and is a compulsory patient under the Mental Health (Compulsory Assessment and Treatment) Act 1992.

The man complained that he was assaulted by his primary nurse in the dining room at the facility. The man and the nurse told HDC different versions of events: the nurse said the man tripped and fell, whereas the man said the nurse pushed him. In any event, when the man was on the floor, the nurse sat on the man’s body and bounced on him, and did not remove himself promptly from this position. The nurse did not document the man’s fall or report the incident.

The Deputy Commissioner found that these actions amounted to an unreasonable restraint. She was also critical that two other staff members did not report the incident.

"The nurse’s conduct is wholly unacceptable, especially in the case of such a vulnerable consumer, and I am critical of his actions," Ms Wall said.

Ms Wall noted that the DHB had conducted a thorough internal investigation, and the nurse’s employment was terminated as a result.

Ms Wall recommended that the nurse’s employer, the DHB, provide evidence of recent training to staff on incident reporting; conduct an audit of incidents reported over the last three months to ensure that incidents have been documented appropriately; and review its protocols for staff who notice adverse practises.

She also recommended that should the nurse wish to obtain a practising certificate, the Nursing Council of New Zealand consider his fitness to practise, and that the nurse and the DHB apologise to the man.

The full report on case 18HDC01604 is available on the HDC website.

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