Restraining unruly hospital patients – Inquest into the death of Andrew Osborne
The inquest into the death of Andrew Osbourne looked at the appropriateness of the use and manner of physical restraint of a person affected by drugs in a hospital setting.
On the morning of his death, Queensland Police Service (QPS) were called to a disturbance at a home occupied by Mr Osborne’s friends. Mr Osborne had refused to leave his friends’ property because he was frightened to do so. QPS subsequently drove Mr Osborne to the Caboolture Hospital after he reported that he was suffering a drug induced psychosis.
Mr Osborne was triaged at the hospital but subsequently became anxious and did not want to wait in the Emergency Department. Mr Osborne left the Emergency Department and tried unsuccessfully to gain access to the Mental Health Unit. As the security doors were faulty, he then proceeded to wander around other hospital wards that he should not have been able to access.
The hospital nursing and security staff tried to persuade Mr Osborne to return to the Emergency Department from Ward 2A, a ward where patients were recovering from surgery. He refused to do so, and a struggle ensued with security officers. Mr Osborne was then restrained on the floor by hospital staff for over ten minutes, and QPS was called to remove him from the hospital.
When the QPS officers arrived at Ward 2A where Mr Osborne was handcuffed, it soon became apparent that he was unresponsive. Attempts to resuscitate Mr Osborne were unsuccessful.
The cause of Mr Osborne’s death was determined to be the combined effects of drugs and being restrained in a prone position for over ten minutes. A number of factors contributed to his death, including the proarrythmic effects of the amphetamines and other stimulants he had taken, on his heart. The restraint also resulted in production of an acidotic state, with marked release in catecholamine and lactate. It was not possible to separate the various factors that contributed to Mr Osborne’s death.
The State Coroner found that the hospital’s attempts to persuade Mr Osborne to voluntarily leave Ward 2A were reasonable. Given the close proximity of Mr Osborne to sleeping and vulnerable patients, and his level of intoxication from illicit drugs, the decision to have him restrained and removed from the ward was justified.
The evidence of witnesses to the restraint was that Mr Osborne violently resisted, and it was necessary to apply significant force to maintain the restraint in the interests of patient and staff safety. However, Mr Osborne only struggled significantly for a short time at the beginning. The expert evidence was that restraint of Mr Osborne in a prone position was a factor that contributed to his death. The contribution of this factor could have been minimised had he been rolled onto his side after he stopped resisting. The use of handcuffs may have made that course easier, but they were not made available to hospital security staff at that time.
The hospital response team monitored Mr Osborne’s vital signs during the restraint. This showed an awareness from the attending medical staff that his health was at risk during the restraint. There was inconsistent evidence as to Mr Osborne’s oxygen saturation levels. The Coroner found that it was difficult to reconcile the oxygen saturation levels recorded by hospital staff and their view that Mr Osborne was in good health during the restraint. The evidence of the attending QPS officers was that it was immediately apparent that Mr Osborne was unresponsive when they arrived.
However, the Coroner ultimately found that Mr Osborne’s skin pallor is likely to have changed just as the QPS officers arrived and the qualified hospital staff did not simply fail to notice his deteriorating health as the restraint progressed.
As to the adequacy of staff training in the act of physically restraining a person, the Coroner found that the senior hospital staff in attendance throughout the restraint had received high levels of training, but the training of the four persons who physically restrained Mr Osborne was inadequate. However, given the multi-factorial causes of the death, the Coroner could not conclude that a lack of training played a role in Mr Osborne’s death.
The QPS officers who attended the hospital were only tangentially involved in the restraint of Mr Osborne. The Coroner found that they acted professionally and appropriately.
Following Mr Osborne’s death, the hospital implemented a number of changes which the Coroner found were likely to reduce the prospect of a reoccurrence of the events contributing to the death, including:
- Handcuffs and body worn cameras are available for use by security officers.
- Ensuring that malfunctioning fire doors were replaced, and that wards are secured by locked doors after hours.
- Refining membership of the response team called in situations where physical restraint may be required.
- Installing additional CCTV cameras.
- Extra funding allocated for further security officers.
While the hospital’s position with respect to training had improved, the Coroner found that the mechanism by which training is coordinated, monitored and delivered remains unclear. In light of this, the Coroner made the following recommendations:
- A review be conducted in order to establish clear lines of communication and authority between Metro North Protective Services and the line managers within individual hospitals in that health district to ensure that mandatory training in occupational violence prevention is undertaken, particularly by those on emergency response teams.
- Consistent with QPS policy, hospital staff who are members of emergency response teams and who fail to demonstrate competence in restrictive practices training are not to be deployed to perform such practices.
- The hospital and health service consider adopting aspects of the QPS’s practical training in relation to the physiological impacts of positional asphyxia to reinforce the risks of prone restraint to those engaged in this practice.
Inadequate training in restrictive practices can have a serious impact on the welfare of persons being restrained. The Coroner’s recommendations send a clear message that hospital and health services ought to refine and maintain the skills of persons involved in the implementation of restrictive practices, and ensure that staff are aware of the physiological implications of unsafe practices.