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  4. Maish v State of Queensland (Queensland Health) (No 2) - [2023] QIRC 362

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Maish v State of Queensland (Queensland Health) (No 2)[2023] QIRC 362

Maish v State of Queensland (Queensland Health) (No 2)[2023] QIRC 362

QUEENSLAND INDUSTRIAL RELATIONS COMMISSION

CITATION:

Maish v State of Queensland (Queensland Health) (No 2) [2023] QIRC 362

PARTIES:

Maish, Megan

(Appellant)

v

State of Queensland (Queensland Health)

(Respondent)

CASE NO:

PSA/2023/112

PROCEEDING:

Public Sector Appeal – Fair Treatment

DELIVERED ON:

19 December 2023

MEMBER:

Knight IC

HEARD AT:

On the papers

Conferences held on 30 June 2023 and 12 July 2023

Respondent's Submissions filed 9 August 2023

Appellant's Submissions filed 22 August 2023

Respondent's Reply Submissions filed 30 August 2023

The ABDM Procedure, v3.5/10/2022 filed 24 November 2023

ORDERS:

The decision appealed against is confirmed.

CATCHWORDS:

PUBLIC SECTOR – EMPLOYEES AND SERVANTS OF THE CROWN GENERALLY – appeal against a decision pursuant to s 134 of the Public Sector Act 2022 (Qld) – show cause process – whether Appellant authorised physical restraint and administered unwarranted intra-muscular anti-psychotic medication to a patient – whether Appellant accurately reported details of an incident in Riskman system – where both allegations substantiated – whether decision was fair and reasonable – appeal dismissed

LEGISLATION AND INSTRUMENTS:

Industrial Relations Act 2016 (Qld) ss 562B, 562C

Mental Health Act 2016 (Qld) ss 3, 272

Public Sector Act 2022 (Qld) ss 91, 132, 134

Code of Conduct for the Queensland Public Service (1 January 2011) cl 3

Documentation of Clinical Incidents in RiskMan®, Metro South Health Procedure, v1.0

The Adult – Acute Behavioural Disturbance Management (ABDM) within the Acute Adult Inpatient Psychiatric Units, Metro South Health Procedure, v3.2/11/2021

The Adult – Acute Behavioural Disturbance Management (ABDM) within the Acute Adult Inpatient Psychiatric Units, Metro South Health Procedure, v3.5/10/2022

CASES:

Goodall v State of Queensland (Supreme Court of Queensland, Dalton J, 10 October 2018)

Reasons for Decision

  1. [1]
    Ms Megan Maish is employed by the State of Queensland on a permanent part-time basis as a Clinical Nurse, Adult Acute Inpatient Services, Addiction and Mental Health Services through Queensland Health ('the Department') at the Princess Alexandra Hospital ('the PAH').
  2. [2]
    Ms Maish appeals a decision made by Ms Linda Hipper, A/Executive Director, Addiction and Mental Health Services, Metro South Health on 1 June 2023 ('the Decision') in which she substantiated two allegations.[1]
  3. [3]
    The allegations relate to Ms Maish's performance of her duties while treating a patient at the PAH in the Adult Acute Inpatient Services Unit ('the Unit') on 15 September 2022.
  4. [4]
    Such an appeal proceeds under ch 7 pt 1 of the Public Sector Act 2022 (Qld) ('PS Act') and under ch 11 pt 6 div 4 of the Industrial Relations Act 2016 (Qld) ('the IR Act').[2] It is not by way of rehearing, but rather involves a review of the decision arrived at and the decision-making process therein.[3] Its stated purpose is to decide whether the decision appealed against was fair and reasonable in all the circumstances.[4]
  5. [5]
    I note that in addition to appealing the substantiation of the allegations, Ms Maish, while participating in proceedings related to the appeal, raised concerns about proposed disciplinary action set out within a second show cause notice,[5] namely:
  • Reduction in classification level and consequential change of duties.

The reduction would result in you returning to Registered Nurse, Nurse Grade 5, paypoint 7 from Nurse Grade 6, paypoint 4.

  • Transfer or redeployment to other public service employment

This may involve you transferring to a different inpatient service within MSAMHS.

And; I am giving serious consideration to a proposed management plan which will consist of:

  • 3 months professional development plan
  • Support with leadership skills
  • No in-charge shifts for 3 months[6]
  1. [6]
    It is not in contention that a final decision is yet to be made by the Department in relation to any disciplinary penalty.
  2. [7]
    A 'proposed' penalty is not a decision that can be appealed under section 132 of the PS Act. Therefore submissions made or orders sought relating to the proposed disciplinary penalty are beyond the scope of this appeal.
  3. [8]
    The issues to be determined therefore, are:
  • Was it fair and reasonable for Ms Hipper to conclude Ms Maish engaged in the conduct detailed within the two allegations; and
  • Was it fair and reasonable for Ms Hipper to conclude Ms Maish contravened, without reasonable excuse, the relevant standard.
  1. [9]
    For the reasons that follow, I consider the decision appealed against was fair and reasonable in all the circumstances.

Background

  1. [10]
    In October 2022 the Department received a telephone complaint from a former patient of the PAH Adult Acute Inpatient Services Unit. The patient raised concerns about having been administered an intramuscular injection (IMI) unnecessarily and in contravention of s 272 of the Mental Health Act 2016 (Qld).[7]
  2. [11]
    The management of acute behavioural disturbance within the PAH Adult Acute Patient Unit is governed by the Mental Health Act and the Adult – Acute Behavioural Disturbance Management (ABDM) within the Acute Adult Inpatient Psychiatric Units ('the ABDM Procedure').[8]
  3. [12]
    The ABDM Procedure[9] requires that adult patients exhibiting moderate to severe agitation or behavioural disturbance should be managed in accordance with a three-step pathway, namely:
  • First Line: Non-pharmacological measures (i.e. de-escalation strategies);
  • Second Line: Oral line medications;
  • Third Line: Intramuscular medications.[10]
  1. [13]
    The basis of the first Allegation against Ms Maish is that she contravened the ABDM procedure by bypassing the first and second line treatment options, instead choosing to administer intermuscular medication when it was not warranted.
  2. [14]
    The Department referred the complaint to the Crime and Corruption Commission ('CCC') for consideration.[11] Ms Maish was subsequently directed to undertake alternative duties in lieu of being suspended. The duties consisted of administrative tasks within the Woolloongabba Community Health Centre.[12] 
  3. [15]
    On 6 December 2022, the CCC, having assessed the matter, advised it was content with the Department progressing the management of the matter internally.[13]

Show Cause Process

  1. [16]
    On 10 January 2023, Ms Maish was issued a Notice to Show Cause in respect of two allegations,[14] namely:
  1. On 15 September 2022, in your role as a Clinical Nurse, East Wing, PAH, you authorised the physical restraint of a patient, whilst you administered an IMI anti-psychotic medication to him, despite it not being clinically indicated.
  2. On 15 September 2022, in your role as a Clinical Nurse, East Wing, PAH, you documented false information in a Riskman Report in relation to the same patient.
  1. [17]
    Ms Maish viewed the body worn camera footage of the incident described in (a) with a union representative on 24 January 2023.[15]
  2. [18]
    Throughout the disciplinary process Ms Maish was supported by the Queensland Nurses and Midwives' Union ('QNMU').

Ms Maish's Response

  1. [19]
    On 7 February 2023, Ms Maish responded to the Notice to Show Cause.[16] The response included the following points in relation to Allegation One:
  • Having admitted the patient, Ms Maish became aware of his medical history and presenting risks, which extended to a history of domestic violence, suicidal risk and alcohol withdrawal;
  • The patient had previously been non-compliant with medications;
  • On an earlier occasion, the patient had become aggressive with staff after his cigarettes were confiscated;
  • The patient was known to disagree with staff who attempted to establish boundaries relating to safety protocols or other processes;
  • At the time of the incident, the Unit was under pressure due to staff assisting with other patients;
  • The behaviour of the patient escalated when he was requested to wait until a nurse became available to discharge him from the Unit for a short period of leave; and
  • The patient became increasingly agitated while waiting to be released, eventually yelling at another nurse, which Ms Maish interpreted as a sign of possible imminent danger.
  1. [20]
    In her show cause response, Ms Maish acknowledged she was aware of the correct pathway for restraint and recognised IMI medications were a last resort, but asserted the patient's medical history was complex having regard to his heavy drinking and prior conduct.[17]
  2. [21]
    Ms Maish maintained that both herself and another nurse exercised their clinical judgement when assessing the risks associated with the chosen pathway, observing:

I believed at the time that the refusal to take the oral medication to the point of significant escalation, and after extensive nursing support to assist him with taking this pathway, constituted an ongoing refusal to take oral medication indicated the IMI should be administered. Coupled with the complex case load, the additional conditions the patient was being treated for, and the history of violence and risk to staff and myself, Mashnul and I took the decision to continue with the IMI once it was drawn.[18]

  1. [22]
    Ms Maish submitted that while the ABDM Procedure could have been utilised to issue oral medication,[19] it was difficult to apply the policy without error or deviation in an environment where there were insufficient staff and workplace stressors, including the threat of violence.[20]
  2. [23]
    In her show cause response, Ms Maish set out a series of other reasons as to why she administered the IMI, including:
  • PO meds were offered and declined in the courtyard prior to the flash point this is where it was identified that the patient declined the medications and said he had zero intention of taking anything provided to him
  • Once the medications were drawn up, we had already spent 17 minutes in the room leaving only one young female staff member on the floor to manage all 15 patients and no one could egress to go back to the medication room as there was simply no staff, we had to put the plan in motion for safety
  • The meds Navdeep offered the consumer was Diazepam which is not as an ABDM medication as it takes upwards of 60 minutes to have noticeable effects and 90 minutes for peak medication administration. This drug was charted explicitly for CIWR-Ar withdrawal protocols and would therefore absolutely not have been an appropriate first line for ABDM, the use of the CIWR-Ar protocol also meant that because of the use of Diaz for withdrawing from 30 standard alcoholic drinks Lorazepam was not available or charted for use.

...

  • At no point in the video do staff sound malicious or vindictive or angry (we all attempted to reassure the patient) and this is a reoccurring theme on all of the escalations I attend. ... the focus remained on safety for his wife, himself and my staff member who he had just tried to assault... We left his phone with him to try and provide reassurance and comfort. When he was calmer and no longer emotionally dysregulated I had his nurse assess him for leave...
  • Even when the injection was deemed the pathway, we were enacting to mitigate a staff assault, all staff members present attempted to reassure the patient that his trauma history would be respected, and the injection could be given in the hip and that his pants would not be pulled down. He was asked to comply with the injection so it could be given without any restraint in a quick and safe format, and I identified to him that I want his medication to be as minimally invasive as possible.[21]
  1. [24]
    Ms Maish disagreed with the allegation she refused to administer PO [oral] medication, submitting:

Part U of allegation two states I refused to administer PO meds but as documented in the riskman and email I offered them up until the decision was taken to administer an IMI. The patient was offered oral meds prior to screaming homicidal threats of violence at Gina and moving my body with force backwards to move towards her, at this point Mashnul and I had to leave the floor to draw up meds leaving Gina absorbing the constant and Jessica as the only staff member attending to the floor. Prior to drawing up the meds the patient had actively refused the offered PO meds. There was only one staff member on the floor and there was no one to leave the patient with to go get different meds as this would have required the two nurses in the room leaving to retrieve the red keys and the medications. It was not able to be completed with the amount of staffing we had present. I recognise now that the email is not clear about the timing of the offering and refusal of the oral meds. This is an error that I have tried to detail more fully and accurately in this response. What I hope is clear is that the email is an accurate record of the situation until after the decision to administer IMI and after the arrival of security. At that time extenuating, difficult and highly stressful circumstances played into the event led to the completion of the administering of the IMI.[22]

  1. [25]
    In response to Allegation Two, whereby it was alleged Ms Maish documented false information in the Riskman Report about the incident, she submitted:

I at no time meant to mislead with the riskman containing that the medication was refused I was simply identifying that the medication had been offered and concretely refused in the courtyard and I was trying to remember the even hours after when I was under significant distress from the patient entering my physical space and forcing me backwards to get to my staff member and the chemical response likely gave me some tunnel vision as I was not able to watch the footage while writing that riskman and it was from memory hours after the event under time pressures of finishing the shift.[23]

The Decision

  1. [26]
    On 1 June 2023, Ms Hipper issued correspondence addressed to Ms Maish confirming both allegations had been substantiated.[24]
  2. [27]
    Ms Hipper's conclusions in respect of Allegation One, included:
  • I have reviewed the Body (sic) Work Camera (BWC) footage in relation to this matter, and Consumer UR2222921 is heard agreeing to oral medication three times and you have continued to authorise the restraint whilst you administered the IMI.
  • I have taken into account your submissions that patient UR2222921 was threatening physical violence against another staff member. However, I note that the consumer did not appear escalated in the BWC footage, yet you have insisted that he receive the IMI.
  • Your response indicates that you were aware of the correct procedure, however, have chosen not to follow it in this instance.
  • As a SN, it would be expected that you are able to adapt your practice to evolve with the situation at hand. It is of concern to me that you have dismissed consumer UR2222921 request for oral medication and persisted with the administration of IMI.
  • Your actions may have led to significant detrimental outcomes for the consumer.
  • Having regard to the evidence before me, including your admissions in respect to your involvement in this incident, I am satisfied you have failed to follow the MSAMHS Aggressive Behaviour Management procedure pathway for adult patients or demonstrated the level of conduct that I would expect from an experienced CN.[25]
  1. [28]
    Similarly, Ms Hipper determined Allegation Two was able to be substantiated, noting:
  • I have reviewed RiskMan report incident ID 4255683 which states the consumer was given every opportunity to have oral medication, but this was refused.
  • I have reviewed the BWC footage in relation to this matter, and Consumer UR2222921 is heard agreeing to take oral medication three times and you have continued to authorise the restraint whilst you administered the IMI.
  • I note also in the RiskMan report incident ID 4255683, it states given extreme escalation needed quick IMI treatment.
  • In the BWC I have reviewed, it doesn’t appear to me that patient UR2222921 was escalating.
  • I have taken into account your submissions that patient UR2222921 was threatening physical violence against another staff member, however, on the BWC footage I have reviewed, the patient was not threatening violence, he states he did not want to participate in the IMI and wanted to take oral medications as an alternative.
  • Having regard to the evidence before me, including your admissions in respect to your involvement in this incident, I am satisfied you have failed to follow the Documentation of Clinical Incidents in RiskMan procedure or demonstrated the level of conduct that I would expect from an experienced CN.[26]
  1. [29]
    In respect of both allegations Ms Hipper concluded Ms Maish contravened clause 3 of the Code of Conduct,[27] namely:

Standard of conduct

3.1  Commit to our roles in public service

Our role is to undertake our duties, and to give effect to the policies of the elected government, regardless of its political complexion.

We will:

 ...

 c.  comply with the laws of State, Australian and local governments

 d.  comply with all relevant awards, certified agreements, subsidiary agreements, directives, whole-of-government policies and standards, and

 e.  adhere to the policies, organisational values and organisational documents of our employing agency.[28]

Grounds of Appeal

  1. [30]
    In Ms Maish's notice of appeal, filed on 8 June 2023, she relies on the following grounds:
  1. The decision was made having regard to subjective evidence;
  1. Footage of an earlier interaction between the patient and a staff member was 'allowed' to be deleted; 
  2. Ms Maish was not afforded the opportunity to speak to the least restrictive practice committee when responding to allegations;
  3. Ms Hipper considered biased reports about the medication used during the incident;
  4. The Department failed to interview staff who witnessed the incident;
  5. Understaffing and a lack of expertise on the ward contributed to the incident and led to Ms Maish being blamed;
  6. Unfair use of the disciplinary process;
  7. Ms Hipper did not take into consideration other evidence documenting the risk of physical harm from the patient;
  8. In relation to Allegation Two, the decision-maker failed to consider Ms Maish's bodily responses in a high stress environment event; and
  9. Ms Maish was unable to review the video footage until approximately four months after the incident occurred.[29]

Relevant Principles

  1. [31]
    The PS Act relevantly provides:

91  Grounds for discipline

  1. A public sector employee’s chief executive may discipline the employee if the chief executive is reasonably satisfied the employee has—

  ...

  1. contravened, without reasonable excuse, a relevant standard of conduct in a way that is sufficiently serious to warrant disciplinary action.
  1. [32]
    Section 3 of the Mental Health Act 2016 provides:

3 Main objects of Act

  1. The main objects of this Act are—
  1. to improve and maintain the health and wellbeing of persons who have a mental illness who do not have the capacity to consent to be treated; and
  1. to enable persons to be diverted from the criminal justice system if found to have been of unsound mind at the time of committing an unlawful act or to be unfit for trial; and
  1. to protect the community if persons diverted from the criminal justice system may be at risk of harming others.
  1. The main objects are to be achieved in a way that—
  1. safeguards the rights of persons; and
  1. is the least restrictive of the rights and liberties of a person who has a mental illness; and
  1. promotes the recovery of a person who has a mental illness, and the person’s ability to live in the community, without the need for involuntary treatment and care.
  1. For subsection (2)(b), a way is the least restrictive of the rights and liberties of a person who has a mental illness if the way adversely affects the person’s rights and liberties only to the extent required to protect the person’s safety and welfare or the safety of others.[30]
  1. [33]
    Section 272 of the Mental Health Act 2016 provides:

272  Offence

  1. A person must not administer medication to a patient unless the medication is clinically necessary for the patient’s treatment and care for a medical condition.

   Maximum penalty—200 penalty units.

  1. Subsection (1) does not limit section 374.
  1. To remove any doubt, it is declared that, for subsection (1), a patient’s treatment and care for a medical condition includes preventing imminent serious harm to the patient or others.[31]
  1. [34]
    The stated outcomes of the ABDM Procedure are:

OUTCOME

The aim of management is to:

  • Safely and effectively use medication in conjunction with accepted de-escalation techniques to manage acute behavioural disturbance.
  • Manage behaviour by calming the patient with minimal sedation to allow comprehensive diagnostic assessment/management of the underlying disorder.
  • Reduce risk of harm to others by maintaining a safe environment.
  • Minimise harm and psychological suffering for the patient.
  • Do no harm.

This procedure is applicable to all staff working in the Inpatient Psychiatric Units within MSMAHS.[32]

  1. [35]
    The ABDM Procedure within the Acute Adult Inpatient Psychiatric Units requires that adult patients (18-65 years) exhibiting moderate to severe agitation or behavioural disturbance are to be managed by following a three step pathway,[33] namely:

Maish v State of Queensland (Queensland Health) (No 2) [2023] QIRC 362[34]

  1. [36]
    Step 1 of the Documentation of Clinical Incidents In Riskman® procedure provides:

PROCEDURE – DOCUMENTATION OF CLINCIAL INCIDENTS IN RISKMAN®

STEP 1: Reporting

A Clinical staff member (preferably a staff member present at the time) is responsible for documenting the clinical incident or near miss, the immediate interventions, along with the patient / client / resident's response to the interventions in RiskMan® and the medical record as soon as reasonably practicable after the incident, or within 24 hours. Documentation shall be factual, concise, and complete. 

Where harm may have occurred related to items including, but not limited to, biomedical equipment, medications, or clinical supplies, they must be secured for testing and analysis. Equipment or material lot and serial numbers must be entered into RiskMan®.[35]

…

  1. [37]
    The Code of Conduct for Public Sector Employees relevantly provides:

Standard of conduct

3.1 Commit to our roles in public service

Our role is to undertake our duties, and to give effect to the policies of the elected government, regardless of its political complexion.

We will:

 ...

 c.  comply with the laws of State, Australian and local governments

 d.  comply with all relevant awards, certified agreements, subsidiary agreements, directives, whole-of-government policies and standards, and

 e.  adhere to the policies, organisational values and organisational documents of our employing agency.

What Decisions can an Industrial Commissioner make?

  1. [38]
    In deciding this appeal, s 562C(1) of the IR Act provides that I may:
  1. confirm the decision appealed against; or
  1. set the decision aside and substitute another decision; or
  2. set the decision aside and return it to the decision-maker with a copy of the decision on appeal and any directions considered appropriate.

Was it fair and reasonable for the decision-maker to conclude Ms Maish engaged in the conduct the subject of the two allegations?

  1. [39]
    The evidence before the Commission includes correspondence related to the show cause process, relevant Departmental procedures and a copy of the Riskman report completed by Ms Maish. The Riskman report is relevant in so far as Allegation Two is concerned.
  2. [40]
    The Commission also has a copy of the audio and video footage extracted from body-worn cameras of Safety and Response Officers ('SROs') present during the period in which it is alleged Ms Maish authorised the restraint of a patient and administered the Intra-Muscular (IMI) anti-psychotic medication.[36]

Allegation One

  1. [41]
    Allegation One is that, during her shift on 15 September 2022, in her role as a Clinical Nurse, East Wing, PAH, Ms Maish authorised the physical restraint of a patient and administered an intra-muscular (IMI) anti-psychotic medication, despite it not being clinically indicated.[37]
  2. [42]
    The particulars included:
  1. a.
    At all material times you worked in the position of Clinical Nurse, East Wing, PAH.
  2. b.
    As a mandatory requirement of your role, you are required to undertake training in the Code of Conduct for the Queensland Public Service (the Code).
  3. c.
    As part of your role, you are required to adhere to the Mental Health Act (MHA) 2016 (the Act). As per the Part 1 section 3 of the of the Act, the main objectives of the Act are to be achieved in a way that is least restrictive of the rights and liberties of a person who has a mental illness. (Attachment 1).
  4. d.
    In your role, management of aggressive behaviour disturbance management (ABDM) within acute inpatient settings is guided by the (Aggressive Behaviour Management procedure) (Attachment 2). Physical and Mechanical restraint in the mental health unit is guided by the Physical and Mechanical Restraint Procedure (Attachment 3). Both these procedures are directed by the Act.
  5. e.
    The MSAMHS Aggressive Behaviour Management procedure pathway for adult patients (18-65 years) with aggressive behavioural disturbance for moderate to severe arousal, has four steps, which follow a least restrictive pathway. These include:

  Step 1: Non-pharmacological measures

  Step 2: Oral Medications

  Step 3: IMI Medications

  Step 4: Longer Acting Medications

  1. f.
    As per the pathway, Step 3, IMI medication, is only to be proceeded to if the patient is not responding to second line oral medications or is not accepting oral medications.
  2. g.
    On 15 September 2022 at approximately 17:10, a Riskman report (incident number 4522645) (Attachment 4) was completed by Registered Nurse, Gina Tobin, in relation to Consumer UR2222921's behaviour.
  3. h.
    The Riskman report indicates that Consumer UR2222921 became abusive towards nurses when told it could take some time before nurses could organise for him to go on leave.
  4. i.
    As per the BWC footage available, on 15 September 2022, at approximately 17:14, two (2) Safety and Response Officers (SRO's) arrive on the ward.
  5. j.
    The SRO's approach Consumer UR2222921, who is near the airlock entrance to East Wing. Consumer UR2222921 is not visibly aroused at this point.
  6. k.
    You are visible in the medication room.
  7. l.
    Consumer UR2222921 advises the SRO's that the situation has been "blown way out of proportion" and he indicates that he is not having an injection.
  8. m.
    Consumer UR2222921's arousal increases when discussing the event which triggered him to swear at nursing staff. His behaviour does not escalate, and he is directable and de­ escalates when security engage him.
  9. n.
    At approximately 17:17, Consumer UR2222921 follows staff direction and walks to his bedroom and sits on the bed. During the walk to his bedroom, he appears teary.
  10. o.
    For approximately 17 minutes, the security team and Ms Maish speak to Consumer UR2222921 about his previous behaviour.
  11. p.
    During this conversation, you comment that Consumer UR2222921 "screamed homicidal threats" and "terrified you" and this was the indication for the IMI medication.
  12. q.
    Consumer UR2222921 is sitting on his bed the entire time. He uses words to the effect that he was not a physical threat to anyone, and that his swearing was in the context of being upset in the delay to being able to see his wife. He also stated words to the effect that he did not want the injection and could not see why he needed same.
  13. r.
    You continued to maintain that IMI medication was required.
  14. s.
    While Consumer UR2222921 is sitting on his bed, there is a voice of a lady heard coming from his mobile phone, which was reported to be his wife. She was waiting in the foyer/ air­ lock area of the ward to take Consumer UR2222921 out on leave. His wife is heard asking for her husband to be given oral medication, referring to it as first line treatment.
  15. t.
    You refuse to administer oral medication.
  16. u.
    During the event a person identified as the Discharge Facilitator (a Clinical Nurse Consultant) also enters the room and suggests oral medication and offers same to Consumer UR2222921.
  17. v.
    Consumer UR2222921 is heard to agreeing to take the oral medication. You again refuse to follow up on this line of treatment.
  18. w.
    At the 1731 Consumer UR2222921 is physically restrained by the SRO's and you administer an IMI medication in his backside.[38]

Allegation Two

  1. [43]
    The Allegation is that Ms Maish, during a shift on 15 September 2022, in her role as a Clinical Nurse, East Wing, PAH, documented false information in a Riskman Report in relation to the same patient mentioned in Allegation One.[39]
  2. [44]
    In addition to the particulars mentioned above, Ms Hipper outlined the following additional factors considered under Allegation Two:

x. Following the incident, you completed a Riskman report. (Attachment 5).

y. In this report, you state that Consumer UR2222921 “remained refusing to take meds..."

z. You go on to state "The consumer was given every opportunity to have oral medication, but this was refused."

aa. The BWC footage, shows Consumer UR2222921 requesting to receive the (sic) mediation orally.

bb. The information within Riskman ID 4255683 is not consistent with the BWC footage reviewed.[40]

The Evidence

  1. [45]
    The Commission was provided with a copy of body worn camera footage which was taken from cameras worn by two SROs who were requested to attend the Unit on the day the IMI was administered.[41]
  2. [46]
    The footage extends from 17.13 until 17.36, which is the period the SROs physically enter the Unit to the time the IMI anti-psychotic medication is administered by Ms Maish in the patient's room.
  3. [47]
    For the most part, aside from a few instances when the patient becomes visually distressed or angry at the prospect of being administered an injection, he appears to be relatively calm during this period.[42] 
  4. [48]
    The body worn camera footage for the relevant period depicts:
  • As both SROs initially enter the Unit the patient is standing in an internal hallway speaking on the phone to his wife.[43]
  • The patient's wife is standing in the reception side of the internal entrance to the Unit on her phone.[44]
  • The patient appears to be calm while speaking on the phone.[45]
  • The patient is approached by the SROs. The patient can be heard giving the SROs his account about an earlier interaction with a nurse. The patient states he swore at nurse but indicates he does not wish to receive an injection.[46]
  • The patient expresses that the proposal to give him an injection is 'insane'. The patient presents as distressed and tearful at the prospect of being given an injection.[47]
  • The patient co-operates with a request by the SROs to walk to his room for a discussion. The patient continues to raise concerns about being injected with an IMI.[48]
  • The patient enters his room and sits on his bed.[49]
  • The patient and the SROs are engaged in a conversation about his interaction with another nurse. The patient concedes he swore at the nurse.[50]
  • The patient explains he became frustrated with the way he was being treated.[51]
  • For several minutes the conversation appears to be focussed on the patient's explanation as to why he became upset following the delay in his temporary release from the Unit.[52]
  • The patient apologises for the earlier escalation but continues to question Ms Maish's decision to administer an IMI.[53]
  • The patient repeatedly states he does not want the IMI medication. At times, the patient becomes distressed and teary about being injected. On several occasions the patient indicates he is open to accepting oral medication.[54]
  • The patient calls a person who is reported to be his wife and places his phone on loudspeaker. He communicates Ms Maish's intention to administer an IMI. The person [his wife] queries why her husband is not being provided with oral medication and questions whether first line treatment is being administered.[55]
  • The patient raises concerns about the accuracy of Ms Maish's account of his interaction with the nurse in the courtyard.[56]
  • The patient inquires if there is another person he can contact to discuss the issue, insisting that he has 'rights'.[57] He questions the decision to give him an injection.[58]
  • The patient's wife, on speaker phone, observes he does not seem escalated.[59]
  • Ms Maish continues to assert oral medication is not an option and indicates she will be proceeding with the IMI medication.
  • The patient becomes distressed and appears teary at the prospect of being injected.
  • Another medical professional enters the room in the same period and seemingly in response to the patient's request for oral medication, suggests to Ms Maish that oral medication could be an option. Ms Maish disagrees with the suggestion. The staff member exits the room.[60]
  • The patient continues to indicate he does not want an IMI.
  • The patient continues to decline the IMI and requests oral medication.[61]
  • The patient is then forcibly restrained by the SROs as Ms Maish administers the IMI.[62]
  • The patient is distressed. He states he is concerned Ms Maish has not been truthful and again raises concerns about the IMI being administered against his wishes.[63]
  • After the IMI the patient becomes agitated and he can be heard asking the SROs and Ms Maish when he can leave the ward.[64]
  1. [49]
    The body worn camera footage indicates that one of the SROs remains behind in the room to speak with the patient.[65]  

Submissions

Allegation One

  1. [50]
    Although there is no question Ms Maish administered the IMI, she denies following an incorrect practice, maintaining instead that Ms Hipper did not adequately consider the patient's circumstances when concluding the ABDM Procedure had not been followed; submitting:
  1. the Patient was on a doctor assigned treatment for alcoholism, which complicated the standard ABDM pathway;
  2. the Patient previously refused oral medication, voicing an intention to purge any oral medication supplied to him.[66]
  1. [51]
    Ms Maish claims that both she and another nurse independently agreed to prescribe the IMI to the Patient in response to the situation.[67]
  2. [52]
    It is further submitted Ms Hipper failed to consider an email sent by Ms Maish's manager in which she thanked Ms Maish for her report and management of the incident.[68]
  3. [53]
    Ms Maish maintains the decision to administer the IMI was justified having regard to:
  1. A risk assessment undertaken on admission indicated that the Patient had a history of domestic violence, heavy alcohol usage and was assessed as having an increased risk of aggression;[69]
  2. During the clinical handover Ms Maish was advised the Patient was 'a real risk of physical violence including homicidal intent';[70]
  3. The Patient had been verbally assaulting patients and staff before the incident;[71] 
  4. The IMI was administered after the Patient was physically threatening towards another nurse on the ward; and
  5. The IMI was issued in accordance with the Mental Health Act in circumstances where the patient had previously refused oral medication and was on a Treatment Authority.[72]

Incorrect version of the ADBM procedure provided to the Commission.

  1. [54]
    Ms Maish submits the copy of the ABDM procedure supplied to the Commission is an outdated 2021 version, contending Ms Hipper assessed the incident against the more recent 2022 ABDM procedure.[73]
  2. [55]
    Ms Maish argues the two versions of the ABDM document provide different behaviour examples and medication recommendations.

Adequacy of witness evidence

  1. [56]
    Ms Maish questions the adequacy of the show cause process, observing the Department failed to obtain witness statements from staff who were present on the day.

Department's Submissions

  1. [57]
    Although the Department acknowledges the patient may have exhibited aggressive behaviour prior to the incident and concedes inpatient mental health wards are complex and difficult work environments, it contends that at the time Ms Maish administered the IMI, the body worn camera footage confirms the patient was not elevated, was not threatening violence, and had agreed to take oral medication.[74]
  2. [58]
    The Department maintains the body worn camera footage for the period before the IMI was administered confirms the patient was generally compliant with requests from staff, was seated on his bed and once seated, was not aggressive in his interactions and indicating a clear preference for oral medication.[75]
  3. [59]
    For these reasons, the Department submits the footage supports a conclusion the IMI was not necessary or clinically indicated.
  4. [60]
    In response to Ms Maish's reliance on an earlier incident in a courtyard between the patient and another nurse as the trigger for the decision to administer an IMI, the Department submits there was a period of at least 17 minutes between that incident and the time the IMI was administered, in which it was open to Ms Maish to reassess the patient's circumstances and behaviour, including the degree of the patient's arousal, his ongoing reluctance to be injected and his preparedness to accept oral medication.[76]
  5. [61]
    In response to Ms Maish's concerns about the correct version of the ABDM procedure being provided to the Commission, the Department acknowledges the error but submits the version provided to Ms Maish within the initial show cause correspondence on 10 January 2023 was effective from 21 October 2022.[77]
  6. [62]
    In those circumstances, the Department maintains the error has no material impact on the decision made by Ms Hipper, particularly given the ABDM procedure in v3.2[78] was in force at the time the conduct occurred. It is submitted that in any event, the relevant standard against which Ms Maish's conduct was assessed was the same procedure in both versions,[79] namely:
  • First Line: Non Pharmacological Measures (De-escalation)
  • Second Line: Oral Medication
  • Third Line: IM Medications
  • Fourth Line: Longer Acting Medications

Allegation Two

  1. [63]
    Ms Maish submits:
  1. The Riskman was written approximately four hours after the incident and in an environment where the Unit was short-staffed;[80] and
  2. There was no intention to mislead the Department.
  1. [64]
    It is also suggested by Ms Maish that the manner in which she reported the incident in Riskman may have been impacted by 'being assaulted'.[81]
  2. [65]
    Ms Maish argues staff are not able to access CCTV or BWC footage after events or incidents, which she submits would be helpful when preparing Riskman reports.[82]
  3. [66]
    Ms Maish maintains her escalation of the incident to her Manager as requested by the patient, supports a conclusion that there was no intention on her part, to mislead.[83]

Department’s Submissions

  1. [67]
    The Department submits that clinical incidents are required to be recorded in the Riskman system as soon as reasonably practicable after an incident has occurred, and that this record should be factual, concise and complete.[84]
  2. [68]
    The Department maintains Allegation Two can be substantiated on the basis that details recorded by Ms Maish within the report are not supported by the video footage.
  3. [69]
    The Department submits the difference between the two versions available (that is, the version reported in Riskman and the video footage) are beyond what is considered a reasonable error, or difference in opinion, and that it amounts to misrepresentation of the events that took place.[85] 
  4. [70]
    In support of this position, the Department highlighted elements of the report prepared by Ms Maish which it maintains do not align with the events captured in the video footage, namely:
  • That every attempt was made to 'be least restrictive';
  • The Patient continued to refuse medication;
  • The Patient's escalation required quick IMI treatment;
  • The Patient refused to comply; and
  • There was no less restrictive way to ensure the safety of the consumer and others.[86]

Consideration

Allegation One

  1. [71]
    The allegation is that on 15 September 2022, Ms Maish authorised the physical restraint of a patient while administering an intra-muscular (IMI) anti-psychotic medication despite it not being clinically indicated.
  2. [72]
    Having reviewed the materials filed with the Commission, I am not persuaded Ms Hipper's decision to substantiate Allegation One was unfair or unreasonable for several reasons.
  3. [73]
    Firstly, in her role as a clinical nurse within the Adult Acute Inpatient Services (Mental Health), Ms Maish was required to follow the ABDM and the Physical and Mechanical Restraint procedures.
  4. [74]
    It is apparent from the submissions and other materials before the Commission[87] that Ms Maish was aware of these procedures, including the obligations to follow a least restrictive pathway, namely:
  • Step 1: Non-pharmacological measures
  • Step 2: Oral Medications
  • Step 3: IMI Medications
  • Step 4: Longer Acting Medications
  1. [75]
    Secondly, the procedure clearly stipulates the ABDM intervention pathway should be utilised for all adult patients, unless specifically approved by a Consultant Psychiatrist.[88] Relevantly, the ABDM procedure confirms the administering of IMI Medication can only take place if the patient is not responding to second line oral medication or refusing to accept oral medications.[89]
  2. [76]
    The video footage indicates that at the time the IMI was administered, the patient had de-escalated, was compliant and able to be directed to sit in his room, was capable of participating in a coherent conversation and indicated, on several occasions between 5.13pm and 5.36pm, a preparedness to accept oral medication. 
  3. [77]
    Despite Ms Maish acknowledging in her show cause response[90] that it was open to her to have taken oral medication into the patient's room, she went ahead and authorised the restraint of the patient and administered an IMI, notwithstanding the patient was no longer elevated.
  4. [78]
    For these reasons, I consider it was reasonable, having reviewed the video footage, for Ms Hipper to conclude the first step of the management pathway had been successful and the IMI was therefore not necessary nor clinically indicated.
  5. [79]
    Ms Hipper's conclusion that Ms Maish contravened the ABDM procedure by administering the IMI was, therefore, fair and reasonable. 
  6. [80]
    Within her submissions, Ms Maish relies heavily on an earlier incident that took place in a courtyard, where the same patient was verbally aggressive towards another nurse, as a partial explanation for the decision to administer the IMI.[91] It is further submitted the patient had previously been dismissive of staff efforts to de-escalate aggressive conduct and was resistant to accepting oral medications on other occasions.[92]
  7. [81]
    Certainly, I accept that within the PAH Addiction and Mental Health Inpatient Service there will be occasions where a patient who is mentally unwell will be aggressive and unwilling to comply with reasonable directions.
  8. [82]
    However, while it may be the case that the incident in the courtyard triggered Ms Maish's decision to administer an IMI and that the patient had exhibited challenging behaviour in the past, the difficulty with Ms Maish's reliance on this event as justification for the deviation from the ABDM process is that in the period following  the courtyard incident and prior to the administering of the IMI, the patient was no longer elevated, was not threatening or aggressive and was agreeable to taking oral medications.
  9. [83]
    I am not persuaded therefore that Ms Maish had a reasonable excuse for non-compliance with the ABDM. I also consider it was reasonable for Ms Hipper to have concluded there was ample opportunity for Ms Maish to review the patient's conduct, adjust her approach and comply with the ABDM pathway.
  10. [84]
    I am satisfied therefore, for the reasons set out above, that it was open to Ms Hipper to conclude the relevant standard had been breached.
  11. [85]
    I also consider it was open to Ms Hipper to conclude Ms Maish contravened, without reasonable excuse Clause 3 of the Code of the Conduct. This part of the Code requires Ms Maish to 'adhere to the policies, organisational values and organisational documents of our employing agency'.[93]
  12. [86]
    In my view, Ms Maish departed from the Code when she contravened the ABDM procedure and administered IMI anti-psychotic medication despite it not being clinically indicated.

Allegation Two

  1. [87]
    Allegation Two is that on 15 September 2022 Ms Maish documented false information in a Riskman Report about the events that led to her administering the IMI in the manner described above.
  2. [88]
    Clinical incidents at the Adult Acute Inpatient Unit are to be recorded in the Riskman system in accordance with the Documentation of Clinical Incidents in Riskman Procedure.[94]
  3. [89]
    The procedure requires a staff member to document the incident as soon as reasonably practicable after an incident. Moreover, the documentation is required to be factual, concise and complete.[95]
  4. [90]
    Ms Maish maintains she did not intend to mislead her employer noting she was unable to enter the details in Riskman until several hours after the incident. She also relies on extenuating and stressful circumstances within the ward at the time of the incident as an explanation for the inaccuracies that were included within the report.
  5. [91]
    When examining the content of the report, it can be seen that Ms Maish has recorded the incident time as 17.32. This was the approximate time that the IMI was administered.
  6. [92]
    Under the heading 'What Happened?' Ms Maish recorded the following summary:

Restrained to provide IMI only, refusing to comply after escalating in aggression and making verbal threats to harm a staff member, staff continued to ask pt to comply with treatment with security presence.[96]

  1. [93]
    Under the heading, 'Details', Ms Maish included the following comments:

Pt hostile and yelling verbal threats towards a nurse, Riskman for aggression also completed by the nurse that was abused (RISKMAN...). Staff removed patient from the area and took pt to his room escorted by security every attempt was made to be least restrictive, his phone was left on him to speak to his wife until it no longer appeared therapeutic, reassurance was provide that staff had no intent pulling his pants down and could provide the IMI without restraint and without touching the pants- to no effect as he identified a trauma hx. (sic) . remained refusing to take meds, has a CIMHA hx of non compliance with taking meds and given extreme escalation needed quick IMI treatment. Safety response and NIC and another RN all attempted to provide care to patient from 1711-1732 but pt outright refusing to comply. pt restrained on side on bed ( was not prone for any amount of time) @ 1732 and IMI delivered and pt was released immediately and safety response were given a sticker for pt details and left.[97]

  1. [94]
    The difficulty with Ms Maish's report is the video footage for the period 17.13 until 17.36 depicts events which are very much at odds with the description included in the report.[98]
  2. [95]
    For example, while it may have been the case the patient had refused oral medication in the past, the patient can be heard on at least three occasions during this period expressing a willingness to accept oral medication.
  3. [96]
    Even if that was not the case, the footage shows the patient is not escalating, was not threatening to harm anyone and was engaging in a relatively civil manner with the staff who were present in the room. There is no evidence before the Commission that depicts the patient engaged in 'extreme escalation' such that it would warrant bypassing the first and second stages of the ABDM.
  4. [97]
    Finally, notwithstanding a suggestion by a colleague to administer oral medication, the footage does not support a conclusion Ms Maish considered less restrictive practices during the relevant period.
  5. [98]
    Ms Maish relies on the passage of time, the incident itself and other stresses in the workplace as an explanation for the inaccuracies in the report.
  6. [99]
    However, the information included by Ms Maish in the report in respect of the patient's degree of escalation, conduct and refusal to accept oral medication for the nominated period could not be viewed, in any way, as being aligned with the events recorded on the video footage.  
  7. [100]
    At best, Ms Maish appears to have conflated details of the events of an earlier incident within a courtyard at the Unit, where it is claimed the patient was verbally aggressive towards another nurse, with the events that occurred immediately before the IMI was administered, in another part of the Unit between 17.13 and 17.36, such that the report reads as if they are occurring within the same timeframe.
  8. [101]
    At its worst, the description about how the patient was behaving immediately before the IMI was administered, completely misrepresents the events as they unfolded.
  9. [102]
    Although I accept the earlier events in the courtyard may well have triggered Ms Maish's consideration as to whether an IMI should be administered, the footage indicates the interaction between the patient and Ms Maish in the period between 17.13 and 17.36 took place in an entirely different setting and after the patient had de-escalated and expressed a preparedness to accept oral medication.
  10. [103]
    I am therefore unable to accept Ms Maish's explanation for the conduct in Allegation Two.
  11. [104]
    For the above reasons, I consider it was open to Ms Hipper to conclude the account recorded by Ms Maish was false and in doing so, Ms Maish has failed to comply with both her reporting obligations[99] and the Code of Conduct: Principle 3.1 Commit to our roles in public service. [100]
  12. [105]
    I am also satisfied it was open to Ms Hipper to make a decision in respect of both Allegations having regard to her position as A/Executive Director, Addiction and Mental Health Services, Metro South Health.

Other issues

  1. [106]
    Within her Appeal grounds and submissions, Ms Maish raises concerns about the adequacy of the investigation into the Allegations, focusing on the Department's failure to gather witness statements to corroborate her recollection of events and her inability to obtain corroborating statements from staff due to confidentiality obligations.[101]
  2. [107]
    The submissions appear to be particularly directed towards an earlier incident that occurred in the courtyard where the patient was allegedly verbally aggressive towards another nurse but where CCTV footage of the incident had not been retained.
  3. [108]
    In particular, Ms Maish argues:

Despite the 5 CCTV cameras in the area, none of this footage was kept by QHealth and only an edited selection of the security footage from the security officers body cameras was retained and this fails to show the complainant's attempts to violently re-engage with the nurse that the complainant was fixated on soon after the IMI was applied. People with a personality disorder present differently when engaging with violent ideation and are more manipulative and vindictive (per the DSM) and I knew he still possessed aggressive intent towards Gina as he remained hyper-fixated on her while talking on the bed that's why he came straight out to attack her post the IMI administration despite me being there and being the one who gave the IMI. I was not given access to any of the CCTV footage despite QHealth having reviewed it (acknowledged in email). Despite this being pertinent to this case QHealth then knowingly allowed this footage to be deleted in spite of the specific request of the complainant for access to this footage – which is confirmed in the security officer's edited recording.[102]

  1. [109]
    While the CCTV footage or witness statements may have been helpful in terms of establishing a more accurate timeline and in providing further context around the events that initially triggered Ms Maish's consideration about whether to administer an IMI, having reviewed the footage and other materials before the Commission in respect of the period in which the actual incident took place, I am satisfied the BWC footage was sufficient for the decision maker to determine whether the allegations could be substantiated.[103]
  2. [110]
    This is because the events between 17.13 and 17.36 which form the basis of Allegation One took place in an entirely different location and setting within the Unit.
  3. [111]
    Therefore, I do not agree that the gathering of further witness statements would have provided more credible or sufficient information to dispute the evidence provided in the footage for this period.[104]
  1. [112]
    Other concerns raised by Ms Maish include:
  • Not being provided with an opportunity to speak with the Least Restrictive Practice Committee.[105]
  • The Department's failure to provide the Commission with the Patient's chart or documentation from Consumer Integrated Mental Health and Addiction ('CIMHA') which Ms Maish says would have provided the Commission with clarification regarding the events surrounding the incident.[106]
  1. [113]
    While this information may well have provided the Commission with more background and context, I accept the Department's submissions that the information would more appropriately form part of any future consideration by the Department in respect to disciplinary actions following the substantiation of the allegations.
  2. [114]
    Similarly, I am not persuaded an opportunity to speak to the Least Restrictive Practice Committee would have altered the outcome in respect of the substantiation of Allegation One.

Conclusion

  1. [115]
    I am satisfied Ms Maish engaged in the conduct the subject of the Two Allegations, and in doing so, contravened the relevant procedures and standards, and in turn the Public Sector Code of Conduct.
  2. [116]
    For the reasons given above, I consider the decision was fair and reasonable.
  3. [117]
    I order accordingly.

Order

The decision appealed against is confirmed.

Footnotes

[1] Appeal notice filed 8 June 2023.

[2] Public Sector Act 2022 (Qld) s 134.

[3] Industrial Relations Act 2016 (Qld) s 562B(2); Goodall v State of Queensland (Supreme Court of Queensland, Dalton J, 10 October 2018), 5.

[4] Industrial Relations Act 2016 (Qld) s 562B(3).

[5] Appeal notice filed 8 June 2023.

[6] Ibid, Attached Decision issued by Ms Hipper on 1 June 2023.

[7] The Department's submissions filed 9 August 2023, [6].

[8] The Adult – Acute Behavioural Disturbance Management (ABDM) within the Acute Adult Inpatient Psychiatric Units, Metro South Health Procedure, v3.2/11/2021 ('2021 ADBM Procedure'); The Adult – Acute Behavioural Disturbance Management (ABDM) within the Acute Adult Inpatient Psychiatric Units, Metro South Health Procedure, v3.5/10/2022 ('2022 ABDM Procedure').

[9] 2021 ABDM Procedure; 2022 ABDM Procedure.

[10] 2021 ABDM Procedure, 4; 2022 ABDM Procedure, 4.

[11] The Department's submissions filed 9 August 2023, [9].

[12] Ibid, [10].

[13] Ibid, [11].

[14] Ibid, attachment two.

[15] Ibid, [16].

[16] Ibid, attachment three.

[17] Ibid, attachment three.

[18] Ibid, attachment three.

[19] Ibid, attachment one.

[20] Ibid, attachment three.

[21] Ibid, attachment three, 6.

[22] Ibid, attachment three.

[23] Ibid, attachment three.

[24] Ibid, [19].

[25] Ibid, attachment five, 4.

[26] Ibid, attachment five, 6.

[27] Code of Conduct for the Queensland Public Service (1 January 2011) cl 3.

[28] The Department's submissions filed 9 August 2023, attachment five.

[29] Appeal notice filed 8 June 2023.

[30] Mental Health Act 2016 (Qld) s 3.

[31] Ibid, s 272.

[32] The Department's submissions filed 9 August 2023, attachment one, 1.

[33] Ibid, attachment one, 4, 11-12.

[34] 2021 ADBM Procedure, 4; 2022 ABDM Procedure, 4. The flowchart is identical in both Procedures.

[35] Documentation of Clinical Incidents in RiskMan®, Metro South Health Procedure, v1.0, 7.

[36] Video footage filed by the Department on 9 August 2023.

[37] The Department's submissions filed 9 August 2023, attachment five.

[38] Ibid, attachment five.

[39] Ibid, attachment five.

[40] Ibid, attachment five.

[41] Video footage filed by the Department on 9 August 2023.

[42] Ibid.

[43] Ibid, 17:13:53.

[44] Ibid, 17:13:47.

[45] Ibid, 17:13:53.

[46] Ibid, 17:15:02.

[47] Ibid, 17:16.

[48] Ibid, 17:17.

[49] Ibid, 17:17.

[50] Ibid, 17:18.

[51] Ibid, 17:18.

[52] Ibid, 17:18-17:23.

[53] Ibid, 17:23.

[54] Ibid, 17:21.

[55] Ibid, 17:26.

[56] Ibid, 17:27.

[57] Ibid, 17:27.

[58] Ibid, 17:28.

[59] Ibid, 17:29.

[60] Ibid, 17:29.

[61] Ibid, 17:30.

[62] Ibid, 17:32.

[63] Ibid, 17:32:23.

[64] Ibid, 17:33.

[65] Ibid, 17:34-17:36.

[66] Ms Maish's submission filed 22 August 2023.

[67] Ibid, 1.

[68] Ibid, 1, attachment two.

[69] Ibid, 2.

[70] Ibid, 2.

[71] Ibid, 2.

[72] Ibid, 2.

[73] The Department's reply submissions filed 30 August 2023, [16].

[74] The Department's submissions filed 9 August 2023, [31].

[75] Ibid, [31].

[76] The Department's reply submissions filed 30 August 2023.

[77] Ibid, [16].

[78] 2021 ADBM Procedure.

[79] The Department's reply submissions filed 30 August 2023, [17].

[80] Ms Maish's submission filed 22 August 2023, 5.

[81] Ibid, 5.

[82] Ibid, 5.

[83] Ibid, 5.

[84] The Department's submissions filed 9 August 2023, [36], attachment seven.

[85] Ibid, [40].

[86] Ibid, [38].

[87] The Department's submissions filed 9 August 2023, [38].

[88] 2022 ADBM Procedure.

[89] 2022 ADBM Procedure, 12.

[90] The Department's submissions filed 9 August 2023, attachment three, 5.

[91] Ms Maish's submissions filed 22 August 2023, 2.

[92] Ibid.

[93] Code of Conduct for the Queensland Public Service (1 January 2011) cl 3.1(e).

[94] The Department's submissions filed 9 August 2023, attachment seven; Best Practice Guide to Clinical Incident Management (State of Queensland (Queensland Health)), 2014.

[95] Documentation of Clinical Incidents in RiskMan®, Metro South Health Procedure, v1.0, 7.

[96] The Department's submissions filed 9 August 2023, attachment six.

[97] Ibid, attachment six (emphasis added).

[98] Ibid, attachment six.

[99] Documentation of Clinical Incidents in RiskMan®, Metro South Health Procedure, v1.0, 7.

[100] Code of Conduct for the Queensland Public Service (1 January 2011), 3.1.

[101] Ms Maish's submission filed 22 August 2023, 3.

[102] Ibid, 3.

[103] The Department's reply submissions filed 30 August 2023, [19].

[104] The Department's reply submissions filed 30 August 2023, [23].

[105] Ms Maish's submission filed 22 August 2023, 3.

[106] Ibid, 3.

Close

Editorial Notes

  • Published Case Name:

    Maish v State of Queensland (Queensland Health) (No 2)

  • Shortened Case Name:

    Maish v State of Queensland (Queensland Health) (No 2)

  • MNC:

    [2023] QIRC 362

  • Court:

    QIRC

  • Judge(s):

    Knight IC

  • Date:

    19 Dec 2023

Appeal Status

Please note, appeal data is presently unavailable for this judgment. This judgment may have been the subject of an appeal.

Cases Cited

No judgments cited by this judgment.

Cases Citing

Case NameFull CitationFrequency
Maish v State of Queensland (Queensland Health) [2024] ICQ 177 citations
Maish v State of Queensland (Queensland Health) (No 3) [2024] QIRC 912 citations
1

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