NURSE’S DEATH

Dominion, Volume 22, Issue 136, 5 March 1929, Page 8

NURSE’S DEATH

ALLEGATIONS REFUTED NOT FORCED TO WORK “TREATED WITH. SKILL AND KINDNESS” The recent death of Nurse Edith Mary Pavuter of the Porirua Mental Hospital staff and its attendant circumstances were the subject of u lengthy inquiry last month, when several nurses aliegeu that there- had been negligence in Her treatinnnt and that she wad been forced to work when in an untit condition. These charges were refuted in a reserved judgment delievered in the Magistrate s Court yesterday by Mr. J. 8. Barton, b-M. "My first duty, said Mr. Barton, is to make a finding as to the cause of death This offers no difficulty; the evidence points with certainty and precision to the findng that Edith Mary Paynter died at the Mental Hospitabat Porirua on Sunday, February 10, 1.12 J, as the result of cerebral haemorrhage arising from a ruptured aneurism at the base of the brain, and further that the aneurism was a congenital condiwere, however, I certain other matters and questions of a kind proper to be raised at an inquiry of this nature relating to the treatment accorded to the deceased prior to her death. The deceased was a member of the staff of attendants at the said Mental Hospital, and the matters and questions referred to took the form at the inquiry of allegations of unskilful medical treatment, neglect in the matter of nursing, general comfort and proper feeding, and harsh treatment in putting her to work and keeping her to work when she was obviously ill, and, as events proved, approaching her death. “The allegations that found these complaints came from other members of the staff of attendants; they employed counsel to attend the inquiry on their behalf, and thirteen of them gave evidence at the hearing.

Charges Refuted.

“I propose now to formulate the charges and complaints, and append my respective findings to them. First, that, the medical staff attending on Nurse Paynter did not display proper skill in so doing, but negligently (a) * all ® d diagnose the true cause of the patients suffering and illness, and (b) erroneously, diagnosed her’trouble as hysteria. “On the first of these complaints, viz., failure to diagnose the cause of the trouble, I find that an overwhelming array of evidence that refutes the charge or implication • of negligence, or lack of skill Dr. Lynch, an independent medical man, stated in his evidence that there is no .means by which -such aneurisms, congenital in origin, can be detected in life This opinion was strongly, supported bv Dr. Fenwick, who. fortified his .own opinion by reference to a professional publication which presented a summary of ten cases of this disease, ending with the conclusion that such aneurism may -occur no sign or symptom whatever till the bursting of the aneurism causes de “Dr. Lynch, recalled on the last day of the inquest, gave evidence r ®' suits of a port mortem examination, made during the period covered by this inquiry, in which, an almost exactly Simula? aneurism in almost precisely the same office had burst, with fatal results and the history of the case showed no prior symptoms and no complaints by •the victim of the condition. The medical staff who attended on Miss P“yM®J ga J® evidence of sounding and testing the patient, and finding no trac .® lesions; this is borne out by the post rfortem report that all organs were sound „„,i heal th v ; they testified lurtlier . to testing the nervous system, and finding, no evidence of cerebral trouble; this is made entirely credible by the evidence I have already summarised. I , hnd there is no evidence whatever in support condition are known andi cons ldered - “On the second branch of- the co nlaint ” continued the Magistrate, viz., that the medical staff were unskilful in their diagnosis of hysteria, and the tr ® a ment that that diagnosis involved, I a “ d x. thp evidence discloses nothing to ably should have known up to, say, the eU “D°r. STmedical superintendent, ita hie evidence begun with the history sup ied by the paUent’s twin sister, who wis also on the staff of attendants. It related to a severe emotional stress abou two years ago, after which the patient was Confined to bed, restless and with Insomnia for a week. Since returning 11 -om the Islands to New Zealand in December last she had suffered from giddiness, and had been taking asperins tor headache. “Then came thfc incident of January 4, 1929, when the deeeased and anot *!®J nurse were attacked by a patien l or ? week prior to that incident the deceased had complained to her twin sister of feeling unwell, but the incident in (question undoubtedly gaye her a glta * emotional shock, aad device of e iffiy^ai r bijury to the deceased but there was a most marked change in her temperament, bearing, and general health from and after the incident of th “‘“She complained of headache, and this at times was clearly of a most distressing kind and of pains in her shoulders and legs; and these symptoms during Jaumuy seemed to yield to the treatment accorded by the medical staff. There was also vomiting, which seemed to be I ® s ®® l^ d ? y dietetic treatment. At the end of Janu ary the patient was considerably, improved and was able to walk about the drive and ground, and talk with her companions. About January q 27 she began to comnlain of double vision and pain in her eve's. So-n after this the headaches returned, and persisted till her death on February 10. During this period the patient was examined by Dr. Catherine A. - deison, Dr. Hayes, and Dr. Macky, each of whom deposed that there was no apparent sign of organic weakness or■ lesio> . This result was confirmed by the post mortem report that all the organs weie Xml and healthy They «l®o B’stcd the nervous system, and each reported inalii itv to fin'd any signs of derangement 0 interference. Dr. Anderson saw the patient daily, and at an early stage dlag ‘ nosed the trouble as hysteriaifowin. on the severe emotional shock of January 4. Dr. Hayes saw her on •J an " ary and thereafter once a week until the end. “Suffered From Hysteria." “He confirmed Dr. Anderson's diagnosis of hysteria. Dr. Macky saw tlie P' 11 '?." 1 on February 4, examined her, and discussed her symptoms with her and deetd ed it was a case of hysteria. Matro Brand saw the patient daily, and speaking with some cons*derable experience of the malady, she was satisfied that the patient was the victim of hysteria. Dr. Gray, the Director-General of Mental Hospitals, who heard all the medical evidence referred to above, said that the whole history of the case suggested hysteria to him without any doubt. Drs. Lynch and Fenwick, outside practitioners, deposed that they would not care to express opinions in view of the fact that they had not seen the patient, adding that those in contact with the patient were alone able to judge. It is oil these facts that I find that there is much evidence in support of the diagnosis of hysteria and none in support of the contention that diagnosis was unskillful or negligent. , “I accept the evidence of the medical . staff as honest and skilled, and it satisfies

me that in addition to the latent menace of the aneurism, and its premonitory leakage, the patient suffered from hysteria. . , , “Second: Complaints of lack of care and attention. In general terms this complaint is that when Miss Paynter was seen to be ill and unfit for duty no nurse was detailed, or, indeed, available to attend to her; that she was left to the care of a patient; that she was left alone a great deal; that no provision was made for cleaning and tidying her room; that sin was not supplied with dainty or even appetising or proper food; and that in consequence for about three weeks she was neglected and starved. “Dealing with this complaint in equally general terms for the present, I find that the evidence makes it clear that to date there seems to have been no special provision or facilities at this hospital for the comfort of a sick attendant. Matron Braud agreed with this view in her evidence, explaining that in this connection she and the medical staff had to do their best with the facilities that the old buildings provided ; that she was not satisfied with the existing conditions, but had advocated a specially arranged sick ward for sick nurses; that had now been provided and would soon be open and thereafter available. It has been the practice so far for the nurses off duty to attend to a sick sister nurse and to be assisted to some extent by a patient or patients who are reliable for such purpose. From the evidence adduced before me I formed the opinion that the scale of diet used was more in keeping with the somewhat deficient facilities for general attention than with the standard to be expected in a properly constituted sick ward. ,

“Allegation Disproved."

“Turning now to the specific complaints I am satisfied that no nurse was detailed to attend constantly or regularly to Miss Paynter, and that in consequence she was frequently left alone, and that her meals were frequently, or mostly, taken to her by a patient. Most of this finding is simply the application to this case of the general conditions I have already referred to. In particular, however, I find that the patient detailed for duty was safe and satisfactory and well tried on such work; those nurses who attended to give evidence in support of complaints agreed that the use of this patient’s services offered no ground for adverse criticism. “The charge that no provision was made for cleaning and tidying Miss Paynter’s room is again no more than the application to this case of the general conditions that were admitted to exist. I am satisfied that the room did not go dirty or untidy. One of the nurses deposed that when off duty she tidied the room daily and did it so thoroughly that the matron or doctor on their daily visits would see nothing to excite remark or complaint, and she added that the patient referred to also probably worked at keeping the room clean and tidy. “The complaint that the food was not dainty or likely To tempt the appetite of a sick person I have already dealt with. It was further alleged that by reason of ’this fact the patient ate nothing for three weeks. I consider that this allegation is definitely disproved. The patient’s body was in a very wellnourished condition at her death. The masseuse who attended to her daily and massaged her body saw no falling-off in condition. I am satisfied that the matron, the charge nurse, and the masseuse who each saw the patient daily, talked with her on a quite cordial and friendly basis, and I accept their evidence, that no complaint of underfeeding was eVer made to them by their patient. I accept the matron’s evidence that she daily asked Miss Paynter if she had all she wanted, and was answered in the, affirmative. It is abundantly proved that the deceased’s twin sister who was her confidante and constant attendant made no complaint, and in her evidence she stated that she had no cause for complint. “It is clear that in the period of her illness, and especially at the beginning, the patient had little desire for food, but I believe that in relation to the whole period and in general terms, the position in relation to the sufficiency of her food is correctly set out in the report deposed by Matron Brand and made by Charge Nurse Finlay, viz., “She is not taking a great deal but enough’ of nourishment.” Resumption of Work. “Third: That measures, varying from undue persuasion to active' desciplinary measures, were adopted to compel Miss Paynter to resume duty. “I find that there is not a scintilla of evidence in support of this complaint. I am satisfied that, having diagnosed, the trouble as hysteria, and having adopted such measures as rest and quietness, with daily massage, with comparatively satisfactory results, the medical staff took the view that it might be to the benefit of the patient to resume light duties and thus be given an interest that would tend to take her mind off contemplation of her symptoms. I am further satisfied that in consequence of this they put suggestions to the patient that these were put in an encouraging and kindly maiujer, and that they were acquiesced in by the patient, who told the matron and her own swin sister that she thought she would be better off on duty than lying alone or walking about, the drive. This is made clear by the evidence of the twin sister, and I accept the evidence of the matron and charge Nurses Noonan .and Finlay on this point. Four of the nurses who gave evidence in suppoui of this complaint deposed that the deceased said to them that she hail been told tp ‘buck up” yvhen invited to resume work. In my opinion that phrase is far more consistent with friendly encouragement than with anything suggestive of compulsion or undue pressure. As to the suggestion that Miss Paynter’s door was locked as a disciplinary measure in an endeavour to force her back to work, 1 have to say that I was surprised when it was first,made, and amazed that it was persisted in. There is no evidence whatever to justify it! indeed, those witnesses who appeared in sujiport of complaints and close minds were directed to this suggestion, disclaimed any belief in it. It is made quite clear that the locking of the floor for two days was adopted in the patient’s interests when the unwise behaviour of the other nurses in frequenting her room was tending to defeat the medical officers’ instructions of rest and quiet, and a warning notice had failed to remedy the mischief of that unwisdom. “A further complaint was made that B’hen defective vision seemed to add to Miss Paynter’s trouble, she was not given the opportunity to leave Porirua to visit a specialist. That suggestion is definitely disproved by the evidence. The evidence satisfies me that the patient bad been Offered freely the necessary leave, and had herself chosen February 11 so that her twin sister could go with her to visit the specialist. Unfortunately, her death supervened on February 10. Findings Summarised.

“In conclusion, and by way of summarising my findings, I jun satisfied that the complaints, mostly honest complaints, were based on what, in relation to this unfortunate girl’s illness and death, were first, partial truths, second, lack of information, and third, misinformation. “The partial truths were the lack of suitable accommodation ■■for sick nurses, viewed as an aggravation of .Nurse Paynter’s condition ; the fact that her illness seemed to date from the incident of the attack by a patient on January 4, and the fact that having been persuaded to resume duty, she practically fell' dead whilst on duty. “These facts take ou a different complexion at once, when we consider the points at which the complainants had no information. Firstly, there is the previous history, then the fact that her illness commenced at least a week before the attack by the patient; thirdly, the evidence behind the diagnosis of hysteria, the positive evidence of many symptoms, and the negative evidence of no sign of organic or nervous lesion, or derangement. Fourthly, the methods adopted by the medical staff, viz., rest, quiet, the use of sedatives, daily massage, dietetics, and suggestive treatment; and, fifthly, the presence of a congenital aneurism in the head, that could not be discovered by any medical skill, and that made her death at an early date an inevitable conelusion.

‘‘Thirdly, there is the effect of niisinformation. The complaintants believed that the deceased had suffered a head injury on January 4, when in the struggle with the patient, or (as seemed to be more commonly believed) by striking her head on the floor when she fainted. This latter conjecture was definitely disproved

at the inquiry, for the evidence showed Miss Paynter from a kneeling position, fell into the arms of Nurse Bailey. As to the other conjecture, the only evidence in support is the statement made by the deceased to a sister nurse, that she believed she must have had a knock on the head; this statement was obviously an inference drawn from her subsequent sufferings. There is, therefore, no evidence whatever, of any physical injury to the deceased on January 4, and, therefore. no basis for the subsequent chain of reasoning by which the complainants judged after events. In the atmosphere of discontent, rumours circulated amongst the staff; at least two of the complainant witnesses referred in their evidence to these rumours of harsh treatment as the justification for a statement they had made, and these rumours I include amongst the headings of misinformation. “Some of the complainant witnesses gave evidence of statements made to them by deceased during the last week of her life that seemed to bear out complaints of harsh treatment, and I am satisfied that that evidence was given honestly. It was, however, given by young women wb" believed on what seemed to them conclusive evidence that one of their number had received a head injury in the course of her duty, had suffered ereatly thereafter and presumably in consequence of that injury, that the victim had thereafter been put to work again whilst obviously suffering and had in a short time died in harness. It was to minds obsessed with those beliefs that the statements of Miss Paynter were made, and it was those minds that subsequently in an atmosphere laf rumour, distrust, and in some cases resentment, sought to recall and place on record the purpose of the words. Many of those witnesses admitted that they were not close friends of Miss Paynter, and none of them ever made one complaint or reauest in the matter until after the death of the patient. On the other hand, the deceased girl’s own twin sister, who was he? most intimate companion, the matron, the charge nurse and the masseuse, who met deceased daily and had her confidence and who were better informed on the facts of the case, speak of her acquiescence in the suggestion that, for her own benefit, she should resume light dutv. The same words, uttered by the sufferer to witnesses of these two classes, have produced evidence pointing in totally opposite directions, and I find myself unnble to place on the deceased s words the sinister meaning drawn from them by the complainants. “In the result, therefore, I find that, fl) Owing to the lack of up-to-date facilities and arrangements for sick Miss Paynter was, during her illness, left alone a good deal, and there is evidence

that the food supplied to her at times lacked daintiness and tempting qualities; (2) that each of the other specific complaints is definitely disproved; and (3) that during her illness Miss Paynter was treated with skill and kindness.