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Elizabeth Kennedy, Epworth HealthCare: A Legal Perspective: Prevention and Management of Violence in Hospitals
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Elizabeth Kennedy, Epworth HealthCare: A Legal Perspective: Prevention and Management of Violence in Hospitals

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Elizabeth Kennedy, Corporate Counsel, Epworth HealthCare delivered this presentation at the 2013 Safe and Secure Hospital Conference. The comprehensive program addressed the following issues: …

Elizabeth Kennedy, Corporate Counsel, Epworth HealthCare delivered this presentation at the 2013 Safe and Secure Hospital Conference. The comprehensive program addressed the following issues:

Early intervention via early reporting of disruptive, aggressive, and bullying behaviour to minimise work place violence
An innovative training model to help clinicians, security and policy makers respond to the problems of challenging behaviours
Therapeutic sedation in the Emergency Department: Best practice in managing the highly agitated patient
A systems approach to the prevention of Occupational Violence and Aggression (OVA)
Contract management security: The change from in-house security to contract security
Role of the Risk Based Approach throughout the design process
Preventing and managing clinical aggression in the paediatric and youth health setting
The roles, functions and training provided by the Mental Health Intervention Team (MHIT), New South Wales Police Force
Interactions between Police, Health staff, Ambulance and Hospital Security and future directions
A Legal Perspective: Prevention and management of violence in hospitals
Code Grey responses - Are they legal?

For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/safehospitals

Published in: Health & Medicine

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  • 1. A LEGAL PERSPECTIVE: PREVENTION AND MANAGEMENT OF VIOLENCE IN HOSPITALS Elizabeth Kennedy Corporate Counsel Epworth Health Care Safe and Secure Hospitals Conference Sydney October 2013
  • 2. OVERVIEW How do Hospitals typically manage violence and aggression?  Code of Grey responses – Are they legal?  Duty of care to provide a safe place of work vs. duty of care to patients  Are hospital workers any different?  Should we have better legal protection?  Human rights considerations 
  • 3. THE AGE 15 OCTOBER 2013
  • 4. HERALD SUN 1 APRIL 2013
  • 5. HERALD SUN EDITORIAL 1 APRIL 2013
  • 6. EDITORIAL HERALD SUN 1 APRIL 2013
  • 7. ANF ADDS ITS VOICE
  • 8. TED’S THIN BLUE TRAIN LINE
  • 9. “MACHETE ATTACK” ON DOCTORS
  • 10. HOPPER ET AL  Aggression management in a children’s hospital setting MJA 2012; 196 (3): 198-201  Code Grey to deal with patient aggressors at RCH (physically aggressive and self harming) Note: Visitor aggressors mostly verbally abusive  Remedies Verbal de-escalation Physical and mechanical restraint Sedation
  • 11. TOBY MITCHELL
  • 12. HOSPITALS- DUTIES AT LAW Hospitals as employers  OHS  Safety of staff v safety of patients  Charter considerations  Where does legal liability lie?  How do Hospitals discharge their legal duties?  The consequences of failure  legislative changes to Mental Health Act  New crime of assault on hospital workers? 
  • 13. WHAT DO DOCTORS WANT?
  • 14. RED CARD SYSTEM PROPOSED My colleague Bill O’Shea (Alfred) proposed a red card system  Parliamentary hearing 15 August 2011  Proposal was to warn and ban offenders  What about true emergencies?  Danger for hospitals if patients discharge w/o seeing doctor especially with head injuries  Duty to inform of alternatives  Discharge at own risk form likely to be ineffective  Baillieu government reforms  AMA, LIV and Hospitals objected to PSOs in Hospitals 
  • 15. NEW LAW        Under the Justice Legislation Amendment (Protective Services Officers) Act 2011, Protective Services Officers (PSOs) given police powers E.g. to arrest, without warrant, a person who has been released on bail if they believe that person has broken bail conditions. The power to arrest without warrant The Act also gives PSOs the power to arrest, without warrant, a minor who has refused to provide them with their name and address, where the PSO believes they have consumed alcohol See s 118 Regulations state which places are designated e.g. railways taxi ranks, bus stops, car parks What about hospitals?
  • 16. S 118-POWER OF A PSO  An officer who has taken and subscribed the oath has and may exercise, in the execution of his or her duties, the same powers, authorities, advantages and immunities, and is liable to the same duties and responsibilities, as a constable appointed under this Act has and may exercise, or to which such a constable is liable, by virtue of the common law. In addition, an officer on duty at a designated place may exercise all the powers and has all the responsibilities given to or imposed on such an officer under this Act or any other Act
  • 17. CODE GREY         The staff member: Escalates - by calling code grey if the staff member fears for the safety of self and/or others Seeks support - and guidance as needed from their manager Learns for the future - if patient aggression is a factor (refer to Patient Restraint Policy). The Manager: Supports staff - the Manager ensures that the staff member has access to Employee Assistance Program, if needed System improvement - identify and implement any needed systems changes such as identifying need for skilling staff to manage difficult patient behaviour. Documentation - Riskman database.
  • 18. RCH EMERGENCY RESTRAINT AND SEDATION AND CODE GREY           Procedure The CODE GREY team should perform this procedure. Team leader will designate roles before approaching patient (Code grey procedure). All members should ensure own safety, with gloves and goggles. Draw up medication See table above Secure the patient quickly and calmly using the least possible force. At least 5 people are required - see Figure below The patient should be initially held supine. In highly agitated patients, a face down technique may be used at the discretion of the team leader, but be aware of the increased risk of asphyxiation Administer the drugs by intramuscular injection into the lateral thigh (Other options ventrogluteal or dorsogluteal). Beware of the risk of needle stick injury. Further titrated doses of medication may be required depending on clinical response (If medication can be given IV this may be an option if the patient is safe to cannulate) Post sedation care (See below) Patients who have needed emergency restraint & sedation may also require mechanical restraint, although chemical restraint is preferred. Mechanical restraint should be provided by trained personnel only. See mechanical restraint RCH policy.
  • 19. HUMAN RIGHTS The least restrictive way of treating/restraining patients must be found  Restraint policy should reflect Charter rights  Cannot use restraint unless law permits or it is demonstrably able to be justified  E.g. doctor can exercise power under Mental Health Act over P who is mentally ill-involuntary detention   Severe Substance Dependence Treatment Act 2011  How do we manage difficult aggressive and violent patients visitors and others?
  • 20. SECURITY GUARD- MANSLAUGHTER CHARGES
  • 21. THE AGE 1 APRIL 2013
  • 22. PRINCE HENRY’S HOSPITAL EXAMPLE =The consequences of failure  Security used unreasonable force in ejecting a person from Hospital  Assault charges laid  =Full force of the criminal law  Note :Employer is not liable for the criminal acts of employees  (and doesn’t have insurance to cover) 
  • 23. DUTY OF CARE OH&S laws  “so far as is reasonably practicable”  New model Work Health and Safety Act  Safe and without risks to health of “workers and others”  Arrangements for ensuring safety  Duty of care to patients  Duty in an emergency  How are these competing duties discharged? 
  • 24. MENTAL HEALTH ACT 1986 (VIC) Deprivation of liberty is sanctioned by law but  Least restrictive manner possible-see s 4  Seclusion  Observations every 15 minutes  (No other Act prescribes this)  Review by Mental Health Review Panel  VCAT  Antunovic v Dawson & Norfolk Terrace Community Care Unit [2010] VSC 377  Writ of habeas corpus granted-no discretion to withhold 
  • 25. SECTION 4    It is the intention of Parliament that the provisions of this Act are to be interpreted and that every function, power, authority, discretion, jurisdiction and duty conferred or imposed by this Act is to be exercised or performed so that – (a) people with a mental disorder are given the best possible care and treatment appropriate to their needs in the least possible restrictive environment and least possible intrusive manner consistent with the effective giving of that care and treatment; and (b) in providing for the care and treatment of people with a mental disorder and the protection of members of the public any restriction upon the liberty of patients and other people with a mental disorder and any interference with their rights, privacy, dignity and self-respect are kept to the minimum necessary in the circumstances
  • 26. EMERGENCY DEPARTMENTS By nature busy, frenetic pace and place  Trauma patients =  Agitated patients and visitors  Duty of care to patients and staff often in conflict  Consent not required to treat in an emergency  Patients at risk of harm if they refuse to wait  Role of security?  Role of police? 
  • 27. THE PROBLEM
  • 28. LEGAL REMEDIES No power of search and seizure for security officers  (No use of handcuffs)  “citizen’s arrest”-see s.459 Crimes Act 1958 (Note: Baillieu government initially suggested armed guards-see recent press-it has surfaced again)  Restraining orders in favour of a named person not the Hospital-of little use when a patient is unwell  Stalking offences  Use of “contracts”-effective if communicated well  Personal Safety Intervention Orders Act 2010  Role of security v role of police 
  • 29. LEGAL LIABILITY Duty of care to patients  Duty of care to staff  Duty of care to others- visitors, sub contractors, agency  Personal actions for assault  Criminal actions for assault  Worksafe/OHS prosecution  Role of security-employees or contractors? (must show empathy)  Vicarious liability  Code Grey  What other policies? E.g restraint, Code Black 
  • 30. PROPOSED LEGISLATIVE CHANGES New mental health legislative framework  Expected to commence 2014  The Attorney General announced in April that draft legislation will be introduced for longer sentences for people who attack police officers or emergency workers while they are carrying out their duties, including police, ambulance officers, fire-fighters, protective services officers, SES workers or lifesavers, as well as nurses, doctors or other staff in hospital emergency departments  See Media Release April 2012 
  • 31. QUESTIONS

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