Lead Article – February 2021

Who Should Take the Rap?

An elderly lady was unfortunate enough to fall in a shopping centre. She sustained a fracture involving one of her hips and some associated bruising and lacerations involving her face.

She was taken to one of the major hospitals in Brisbane and amongst other therapeutic endeavours, underwent a total hip replacement to manage the hip fracture. This is a standard approach, although patients undergoing a hip replacement following a femoral neck fracture do have a higher rate of post-operative dislocation.

Unfortunately, she did suffer with a dislocation, which was treated by a closed reduction. Eleven days later, the joint dislocated a second time, again being managed successfully with a closed reduction.

Thereafter, the hip has remained located although she appears to be extremely severely encumbered and ambulates little, if at all, outside the home.

Her legal advisors lodged a claim naming both the surgeon and the hospital staff as co-respondents.

Leaving the surgeon aside for the moment, careful scrutiny of the hospital records confirmed that the nursing staff were assiduous in their warnings to the patient about post total hip replacement precautions, made regular notations in the charts that the warnings had been given, engaged with the physiotherapy and occupational therapy staff to ensure that adequate training was provided regularly and accurately, and in fact appeared to have behaved at least as well as could be expected of the nursing profession. Whilst they had been named in the suit, it is difficult to see how any blame could be attributed in that direction.

Coming back to the surgeon, this might be a different matter. The post-operative radiographs demonstrated that the implants had not been expertly positioned, that the risk of dislocation was higher than it might have been, and that he might be at least partially responsible for the misery that the plaintiff now experiences.

Who should take the rap? Well, that’s for the Court to decide. From my perspective however, the nursing staff appear to be beyond reproach.