Answer

Assignment 1: Application of Law and Ethics Modules

The Australian Health Practitioner Regulation Agency (AHPRA) is the law that governs and regulates the conduct of nurses in Australia. Through the Professional Practice Framework (PPF), standardized guidelines are provided to nurses and midwives (The Royal Australasian College of Physicians, 2018). Nurses are required to practice in accordance with the laid down statutes. The mischief sought to be cured by these statutes is the inherent misconduct and errors that correspondingly lead to injury and/or the unnecessary loss of life.

Section 1: Patient Safety

As required under Section 45(2) of the Coroners Act 2003, the coroner officially tabled his findings with respect to the death of Christopher Hammett (Office of the State Coroner Findings of Inquest, 2012). Based on the findings of the coroner into the death of Christopher Hammett, it is made apparent that the patient died due to aggregated human errors (Remeikis, 2012). Hammett was a relatively healthy man who went to the hospital for a routine back surgery. He had been suffering from unresolved back pains thus his general practitioner referred him to Dr. Scott-Young, a medical practitioner who had a divided practice between two medical institutions (Office of the State Coroner Findings of Inquest, 2012). An operation was scheduled and done in a bid to replace an L5-S1 disk in his back. The operation was relatively successful and uneventful. However, shortly after his surgery, he died in April 2005 (Tuttiett, 2012).

The investigation conducted by the coroner unearthed the fact that the death of Hammett was as a result of a series of poor nursing management, particularly with respect to the maintenance of oxygen levels during the evening shifts (Remeikis, 2012). Based on information contained in various medical records, the coroner noted that no unusual events were witnessed during the operation (Office of the State Coroner Findings of Inquest, 2012). In fact, during the operation, his oxygen level was steady as a result of the measures that had been put in place by the medical practitioners therein. After the operation, the patient was transferred to the Post Anesthetic Care Unit (PACU) wherein he was taken care of by two registered nurses namely; Nicholas Turrell and Christine Proud (Office of the State Coroner Findings of Inquest, 2012). At this point, he was the only patient in the unit (Tuttiett, 2012). Whereas the oxygen level was 99% during the surgery, it suddenly dropped to 64% in the course of the making of the transfer from the operation theatre to the PACU (Office of the State Coroner Findings of Inquest, 2012). Although he had been given two doses of morphine after the surgery prior to being transferred to another ward, the receiving doctor in the ward did not examine him (Office of the State Coroner Findings of Inquest, 2012). The presumption was that since his oxygen levels had been stable during the surgery, the same would be replicated at the PACU. A clear progressive chart was, therefore, not kept at the PACU. At the PACU, a morphine dose “was administered at about 7.17pm and 7.18pm” (Office of the State Coroner Findings of Inquest, 2012, p.3). This was “about the time he was transferred from PACU to the accommodation ward” (Office of the State Coroner Findings of Inquest, 2012, p.3). After the PACU transferred Hammett to the accommodation ward, the discharge score at the PACU was inked as 10-10; a full recovery (Office of the State Coroner Findings of Inquest, 2012). This information was misguiding since his oxygen saturation had been low and he had correspondingly been given 4mg of morphine right around the point of his transfer.

The coroner further found that the use of morphine coupled with the sleep apnea suffered by the patient was as a result of low oxygen saturation, as well as, an inappropriate diagnosis (Tuttiett, 2012). Mr. Hammett’s chart also evidenced the fact that the painkiller button had been pressed 125 times within a span of two and a half hours, yet ironically, the attending nurse did not notice that Hammett was in pain. In the PACU, it was also found that the nurse in charge (Mr. Gibbon) left the ward and entrusted the work of taking care of Hammett on Jennifer Valentine, an enrolled nurse who was meant to work under the supervision of the nurse in charge (Office of the State Coroner Findings of Inquest, 2012). Nurse Valentine consequently failed to connect the oxygen mask to the oxygen supply while she was changing the patient’s nasal prongs and after some minutes, the nurse realized that the patient’s oxygen saturation levels had significantly dropped. This anomaly was however rectified by a supervisor. However, without this continued supervision, the enrolled nurse pinned down wrong observations in the chart regarding the variances in oxygen saturation that she had witnessed.

Nurse Valentine finally decided to ask for the assistance of her supervisor since she was concerned about the variance in oxygen levels. Mr. Gibbons attended to the patient between 1 am and 2 am even as he holistically analyzed the situation in the ward (Office of the State Coroner Findings of Inquest, 2012). He increased his oxygen levels and later took a break to sleep. Mr. Gibbons, however, failed to appropriately analyze the situation since it was made apparent that whereas he thought that the patient was asleep, he was actually unconscious (Remeikis, 2012). At the accommodation unit, a nurse checked the patient at 2 pm, it was seen that Mr. Hammett’s eyes were partially open, his skin had a ‘dusty’ color and he could not be roused (Office of the State Coroner Findings of Inquest, 2012). The nurse called an ambulance and Mr. Hammett was quickly rushed to the Gold Coast Hospital where despite the efforts of the medics therein, Hammett was declared dead.

Based on the coroner’s report, it was made apparent that the patient died as a result of the negligence of the nurses. They failed to provide appropriate care as it had been required. There were numerous anomalies with respect to the filing of the patient’s charts. The anomalies in the filing of the charts correspondingly resulted in other anomalies with regard to the course of action that was undertaken by various practitioners. Because of such a factor, it becomes difficult to pinpoint specific culprits for the purpose of reparation. If not for the numerous errors that were recorded by the nurses, the death of Christopher Hammett could have been easily avoided.

Section 2: The Tort of Negligence

A tort is a wrongful action or inaction which results in injury to an innocent party to whom a duty of care is owed. This is generally referred to as the tort of negligence. For a claim in this regard to suffice, various principles have to be satisfied. The first principle that must be satisfied is the existence of a duty of care. The question that arises herein is whether the law recognizes a duty in this kind of scenario (Fleming, 1988). This question must be answered in the affirmative. After it has been proven that the duty of care exists, it must then be proven that there was a breach of duty (second principle) which resulted in injury (third principle) and the injury was primarily as a result of the breach of duty of care (fourth principle) (Fleming, 1988).

In this case, the first nurse whose liability with respect to the tort of negligence will be analyzed is RN Turrell. When the transfer was being made from the PACU to the accommodation ward, RN Turrell transferred nursing care to RN Manton. Based on the statements that were given by nurse Manton, it was made apparent that certain pertinent information was not provided by RN Turrell to the receiving nurse (Guido, 2014). Turrell did not fashion information regarding the desaturation event that was noticed in the PACU. Based on the stipulations underpinned by the Australian Commission on Safety and Quality in Healthcare, medical professionals are generally required to fashion all pertinent information when they are handing over a patient (Australian Commission on Safety and Quality in Healthcare, 2010). This means that Turrell owed the duty to provide the necessary information regarding the desaturation that had previously occurred. His duty was breached since Turrell failed to provide the information. As a result of the breach of duty of care, an actual injury occurred. The medical practitioners in the accommodation ward were not keen to monitor the oxygen levels of the patient partly because they were not aware of the desaturation event. The ultimate result of this omission is that the patient died. In the present case, it may be argued that the omission of RN Turrell with respect to the rendering of the requisite information was not the primary reason for the death of the deceased since various other anomalies were committed by several other medical practitioners that were handling Hammett. Since this fourth principle of causation has not been aptly met, it is imperative that the entire tort of negligence claim may not suffice.

The second nurse that will be analyzed herein is RN Gibbons. At the accommodation ward, Gibbons failed to properly analyze the situation. Whereas he thought that the patient was asleep, he was actually unconscious (Guido, 2014). As a medical practitioner, he owes the duty of competently analyzing the patient so as to determinately take a course of action that will positively assist the patient. Gibbons breached this duty of care. As a result of the breach, Hammett was not taken to the Goal Coast Hospital in time to receive the resurgence treatment that could have made a difference between life and death. It is, however, important to note that Gibbon’s omission was not the primary cause of Hammett’s death since many other corroborative factors caused the death of the patient.

In both instances, it is apparent that a duty of care existed, and that duty was breached, resulting in injury and the ultimate loss of life. It is, however, apparent in both instances that the fourth principle has not been satisfied. It cannot satisfactorily be proven that the omissions of either of the nurses in isolation caused the death of Hammett.

Section 3: Ethical Issues

When the case of Christopher Hammett is analyzed, it is clear that there are several ethical issues that arise. These are issues that may not out-rightly be classified as illegal but which lean towards the question of morality. When ethical dilemmas arise, nursing practitioners become unsure of the cause of action that should be undertaken.

The first ethical issue that arises is with regard to disclosure of information. Nursing practitioners are often faced with a dilemma when making a determination regarding the extent of disclosure to be conducted when handing over a patient to another practitioner (Braunack-Mayer & Mulligan, 2003). There is a delicate ethical balance between too much information and less information. In the present case, Turrell was supposed to fashion all pertinent information that would have assisted in the determination of the appropriate course of action but since he did not disclose all the necessary information, the receiving practitioner was not aware of the desaturation event that had taken place previously.

Another ethical concern that arises in the Hammett case regards the extent to which a practitioner (especially an indentured learner) should trust his own judgment or interpretation. At the accommodation ward, Hammett had removed his oxygen mask at different times and Miss Valentine kept on making replacements thereto (Office of the State Coroner Findings of Inquest, 2012). According to Valentine’s analysis, the constant replacement of masks was the primary cause of the poor saturation levels. She had to rely on her own interpretation since her supervisor was not available. She further had to rely on her own interpretation when she was filling the patient’s chart and the result was that wrong entries were made (Office of the State Coroner Findings of Inquest, 2012).

In the case of Christopher Hammett, various ethical issues arise. The first ethical issue analyzed herein is with respect to disclosure of information. There is a delicate balance between too much information and less information. Practitioners should, however, disclose all pertinent information. The second ethical issue analyzed herein is with respect to the extent to which practitioners should rely on their individual judgment or interpretation.