Carlton Nicholas & Gillian Yearsley - Justice Health
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Transcript of Carlton Nicholas & Gillian Yearsley - Justice Health
SECURITY IN HEALTHCARE FACILITIES
The use/misuse of Security Officers in dealing with persons displaying
challenging behaviours
Cairns and Hinterland HHSService Profile
The Cairns and Hinterland Hospital and Health Service (CHHHS) is responsible for
the delivery of Health Services in a geographical area of 141,000 square
kilometres ranging from Cairns to Tully in the south, Cow Bay in the north and
Croydon in the west.
The HHS outer western region encompasses extremely remote communities.
The CHHHS supports a population of 283,197 which is forecast to grow by 9% by
2026, with the highest level of growth occurring within the in the 65 and over age
group. Tourism is a key industry and contributes to a relatively high transient
population. It is estimated that 9% of the population are Indigenous Australian,
compared to 3.5% for Queensland as a whole.
The CHHHS delivers health services across the continuum of care and also
provides services to the Torres and Cape Hospital and Health Service. Some
higher level acute services are provided outside the CHHHS area in Townsville or
Brisbane.
Security Labour costs 2013/14
Item Cost
Total Security Labour Expenditure $3,335,167
Security FTE funded amount $1,900,972
Expenditure over FTE funded amount $1,434,195
Overtime Amount $ 223,787
Total overspend $1,434,195
Human Resources
January 2008
12 Full-time employees (FTE)
2 Casual employees
External Security Providers (needs basis)
October 2014
16 FTE
1 x 0.5 Part-time
33 Casual employees
External Security Providers (needs basis)
Static Guards
Primary purpose at Cairns Hospital is:
The protection of persons who are at risk of self-harm or the isolation of persons who present as a risk of harm to others.
Used for:
voluntary and involuntary clients under the provisions of the Mental Health Act 2000 (Qld)
admitted persons who are subject to provisions of the Guardianship and Administration Act 2000 (Qld)
persons requiring treatment who could be subject to a common law duty of care
Case Study 1
Young man with a condition that falls under the umbrella of autism spectrum disorder. Subject to an order under the Guardianship and Administration Act.
Welfare stakeholders Appointed Guardian
Parents
Disability Services
Public Housing Authority
Queensland Health
Queensland Police Service
Case Study 1 (cont’d)
The issues
Understands the difference between right and wrong but has no boundaries
History of violence
History of damaging property
Latent paedophile
Current situation
Facing several criminal allegations of assault and criminal damage
Homeless
Confined to his room at the hospital for 365 days to date
24/7 Static Guard presence
Case study 1 (cont’d)
Outcomes
Confinement has led to increased agitation
Frequent damage to room and contents
Assaults on staff
Weight gain due to lack of exercise
Costs
Damage approximately $15,000.00
Food and accommodation – not specified
Clinical care – not specified
Security approximately $55,000 per month
Case Study 2Elderly man suffering dementia
Is alleged to have shaken an elderly person in a nursing home
Actions may have led to the death of that person
Awaiting trial but subject to determination of “mens rea” and fitness to plead
Subject to the Guardianship and Administration Act
In-patient because he cannot be placed locally.
Stakeholders
Appointed Guardian
Public Trustee
Family
Legal Representatives
Queensland Police Service
Queensland Health
Case study 2 (cont’d)
Situation
In-patient for 15 months
No overt acts of verbal or physical aggression
Guard presence is for duty of care
24/7 Static guard presence (cost approximately $55,000.00 p/m)
Removal of static guard presence brought threat of industrial action by other staff
Patient is allowed to leave the premises and cannot be detained if he refuses to return.
Case study 3 Older male who attends three times a week for treatment over the past 8 years.
Volatile and verbally aggressive (threats to harm)
No physical aggression
Moved from satellite sites to Cairns Hospital because of behaviour
October 2012 interaction with a nurse led to the imposition of a security escort to and from treatment
No risk evaluation for security need. Demand by Executive Mgr.
Security escort still ongoing pending decision by Executive.
Cost of escort absorbed in operational budget.
Applicable law
Guardianship and Administration Act 2000 (Qld) Permits treatment without consent Permits use of reasonable force (Sec. 75) to enable that treatment
Criminal Code Act 1899 (Qld) Permits use of force to prevent continuance, repetition of a breach of
the peace and to detain and/or remove the person (Sec. 260) Sec. 546 – arrest without warrant.
Work Health and Safety Act 2011 (Qld) Obligation on all employers and employees to ensure there is no harm
to others in the workplace.
Duty of Care (Common law) Obligation to ensure no harm comes to others.
Case Study 1Use or misuse of security?
The person was admitted to the hospital due to a lack of suitable accommodation.
Restraint for the purpose of treatment, complies with the GAA.
Restraint to prevent harm to others (assaults, damage etc.), complies with the CCA.
Restrictions on liberty to prevent him accosting children, complies with the ‘duty of care’ provisions under common law.
Each instance also complies with the OH&S Legislation.
What authority do we have to deprive him of his liberty in other circumstances?
This matter has now been referred to the Minister for Health and other Government Departments have renewed their efforts to find suitable accommodation without a requirement for a security presence.
Case Study 2Use or misuse of security?
In 15 months as an admitted patient, the dementia sufferer has displayed no sign of aggression and yet staff insist on a guard presence regardless of need or cost.
There is now a need to conduct another risk assessment and probable cause to escalate the matter to the Executive for determination on removal of security from this patient.
is now a need to conduct another risk assessment and probable cause to escalate the matter to the Executive for determination on removal of security from this patient.
Case Study 3Use or misuse of security?
The outpatient has been complying with the agreed behavioural agreement for 24 months. Professional opinion suggests the security escort should have ceased after 3 months.
This matter has been escalated to the Executive for determination.
Conclusion
Risk evaluation to determine guard presence should be carried out at varied stages:
1. Time of admission (mostly perceptual but also based on known history or reputation of the patient)
2. Subsequent detention and/or relocation
3. Weekly/monthly in the case of prolonged retention as an in-patient