Severe criticism of Oakley Hospital

Press, 10 February 1983, Page 13

Severe criticism of Oakley Hospital

PA Wellington Oaklev Hospital and some of its medical and nursing staff have been harshly criticised by a committee of inquiry 'which investigated the death of a patient there last year.

The committee's report levelled serious criticism at the professional leadership of the Auckland psychiatric hospital and said standards of care and treatment were inadequate when Michael Percy Watene died alone in a secure cell in February, 1982. It said: "This criticism applies to both medical and nursing staff involved in his care."

However, while individual responsibilities existed, the report said, the greatest responsibility rested on a system at the hospital which was deficient and inadequate in many respects. "The standards of treatment and care provided to Mr Watene while a patient at Oakley Hospital fell far below those which could have been expected from a psychiatric hospital in 1982.’’

Watene was referred to the hospital on February 15, three days after he was convicted in the District Court at Whangarei on a charge of offensive behaviour and sentenced to seven days jail. he was sent to Oakley after two doctors had judged .him mentally ill, possibly dangerous and possibly suicidal. He died on February 22 from what a pathologist said was in irregular heartbeat after electro-con-vulsive therapy (E.C.T.). A coroner later found Mr Watene died because he was inadequately- observed after the E.C.T. 'had been given, and the committee of inquiry than began its work amid allegations of threats and intimidation against prospective witnesses.

The committee comprised Mr Rodney Gallen, Q.C., (chairman),'a retired principal nurse, Rita McEwan, and the South Australian Health Commission’s Director of Mental Health, Mr Brian Shea.

Its work was conducted in public, but the names of patients and staff members involved in the inquiry were suppressed. In most cases, the names of the people concerned do not appear in the report. The report said that. the answer to the situation which existed at Oakley was not to discipline individual staff members but to change the system. “It would be easy and wrong to react to what has occurred by imposing disciplinary sanctions on individuals who may themselves, in some cases, be the victims of a system within which they have worked,” the report said. “Such action, could too easily form an excuse or temporary palliative, avoiding the more difficult necessity to transform the hospital itself.” '''

However, while stopping short of criticising individual staff members, the report did point “serious criticism” at the hospital’s senior staff, generally.

“Mr Watene’s care was seriously, affected by the lack of strong professional leadership, direction and example.”

Mr Watene arrived at the hospital late in the afternoon of February 15, handcuffed

behind his back and in the charge of five or six prison officers. He was seen by a doctor who was unable to communicate with him. and who noted on an admission slip that Watene had barricaded himself inside a cell with a knife at Mount Eden jail the day before, apparently because he was afriad of other inmates.

Mr Watene did not become the patient of the doctor who examined him. Doctors at Oakley were allocated patients on a rotational basis. The doctor he was assigned to was not on duty at the time of admission, and did not see Watene until the next day.

He was placed in seclusion. in a room known as Strongroom No. 7. the only furniture in which was a mattress and a plastic chamber pot.

Mr Watene’s own doctor did not physically examine him the next day. believing he was dealing with a strong, unpredictable, and potentially violent person.

The committee said that as Mr Watene’s treatment depended on the initial medical examinations. the examinations he was given were “quite inadequate and provided no proper basis for what followed.” It was also critical of the fact Mr Watene was placed in a secure cell with no explanation, saying this should happen under “no circumstances”, and noted no seclusion order was signed, which was a requirement.

Mr Watene’s first dose of E.C.T. was given in the afternoon of February 17. Because the doctor decided it was not safe to inject Watene because of possible violent or uncontrolled movements, the treatment was given “unmodified", without any muscle relaxant or anaesthetic. The decision that it should be given was taken by two doctors in consultation — a decision the committee said “must be questioned".

The doctors could have used ' rapid-tranquilising drugs instead, but believed Mr Watene was too uncooperative and inaccessible mentally, and required urgent treatment for a “potentially life-threatening" condition.

However, the committee said that Mr Watene had displayed no overt violence before this and the medical and nursing notes did not indicate there was a threat to his life or well-being.

When Mr Watene’s cell door was opened that day-so that he could undergo E.C.T., a violent struggle broke out, the report said. Although there was a considerable conflict of evidence about this struggle put before the committee, all those present agreed it became “extremely violent,” the report said. When the door was opened, Mr Watene picked up his full chamber pot and either flung it or used it as a. weapon, hitting one nurse on the nose and injuring him, spraying other staff with urine. The door was immediately shut, then opened again and a nurse spoke to Mr Watene, attempting .to calm him. It was about this time the decision was made to give the E.C.T. shock unmodified.

A charge nurse went and fetched a.~ mattress which

was then used in the "extremely violent" struggle to subdue Mr Watene.

Allegations were made to the committee that Mr Watene was punched and kicked by nursing staff during this' struggle, but this was denied by some members of the staff and a doctor who was present. The committee found that incidents may have taken place which were misconstrued and there was not enough evidence for it to conclude assaults occurred.

However, the committee said there were a number of aspects of this "whole distasteful incident" that were unacceptable. These included the lack of preparation of Mr Watene for forthcomming treatment, the method of approach adopted towards him, the way he was overpowered and the way the E.C.T. was administered to him.

"It appears to us that no ... adequate systems of safeguards exist at Oakley Hospital and they should be established as soon as possible."

On February 18. Mr Watene was again givem multiple unmodified E.C.T. The.committee said no convincing reason had been put to it which supported this.

"It is believed that an attempt should have been made to give this second E.C.T. in the normally modified form,” the report said. Modified E.C.T. was given on February 20 and February 22, the day of Mr Watene’s death.

On February 22, Mr Watene was attended by a number of staff after E.C.T. until eventually being left alone, his cell door closed.

A psychiatric assistant looked at him twice through the observation panel in the door and was certain Mr Watene was alive at both those times, his chest rising and falling as he breathed. Later, a staff nurse looking

through the panel felt Watene was too still and something was wrong. He called another nurse and they went in to find Mr Watene’s colour was not good.

One nurse went for a doctor. while the other tried to resuscitate Mr W’atene until the doctor took over. The resuscitation attempt continued for 10 to 15 minutes before it was judged that Mr W’atene had died.

Throughout Mr Watene’s time in Oakley he was given various drugs including haloperidol. a powerful antipsychotic.

High levels of this drug, the effect of which has to be monitored at frequent intervals. were given to Mr W’atene from 3.30 p.m. on February 18 to about 9 a.m. on February 22, the day he died.

During that time he was examined by a doctor only once and the. administration of the drug went on unaltered from the initial prescription.

"The failure to maintain regular monitoring over this period is strongly criticised," the report said. “We are gravely concerned by this failure to maintain an intensive medical oversight over Mr Watene’s clinical condition and the failure to regularly review and adjust the very high levels of medication prescribed for Mr Watene over this period.

“We believe that such a practice warrants our concern.

“It is not sound clinical practice to leave such important observations solely to the nursing staff with instructions to record blood pressure,” • the report said. The report said a man had died at Oakley who need not have.

However, it added “a witch hunt at this stage would be unlikely to change the system and might help t'c perpetuate it."