The
following letter was written in response to two incidents involving
Ms H and the NSW Ambulance Service. There was to be another similar
incident a few months later that could well have led to a tragic
conclusion. Unlike NSW Health, which has gone out of its way to not
answer questions or resolve conflicts, the NSW Ambulance Service has
been terrific in both respects. So too have been the police – often
placed in the invidious position of having to act in accordance with
protocols that they knew to be absurd. As for myself, as Primary
Carer, it is a year down the track and I still have no idea whose idea it
was to put these protocols in place. Neither myself nor Ms H were
consulted in the process and nor were we ever told they were in
place. We only ever found out when the protocols were implemented.
Mr
Tony Gately
District
Manager
NSW
Ambulance Service
60
Isis St, Wahroonga
NSW
2076 9th
June 2011
Dear
Mr Gately
Please
accept this letter as a complaint about the NSW Ambulance Service and
also as my attempt to get answers to some questions. It relates to an
incident last night (8th
June) and another last week (2nd
June) at (address) – the home of Ms H. I will start with last
night, since I was present on this occasion and there can be no doubt
in my mind as to the sequence of events.
At
around 10.30 pm Ms H called me from my bedroom (I had gone to bed) to
tell me that she was feeling ill. Given the severity of the pain in
Ms H’ chest and left arm and the tingling sensation in her face, I
felt it best to call an ambulance – hoping that my presence, as Ms
H’ Primary Carer, would make it unnecessary for there to be a
repeat of the events of 2nd.
June when the police were called and Ms H placed in restraints. When
I spoke with the ambulance operator at about 10.45 pm she assured me
that the ambulance officers would not involve the police in a visit
to her home such as this unless the Ms H made threats against
ambulance officers or behaved aggressively. I imagine that a
recording of this conversation will have been made.
Fifteen
or so minutes later an ambulance arrived at (address). I expected the
immediate arrival of the ambulance officers at the front door but
when, after a few minutes, they did not arrive, I walked out into the
street where they were parked to ask them if they were waiting for
the police. Yes, the driver replied. A brief conversation ensued. I
asked the ambulance officers if Ms H had ever either threatened
ambulance officers or behaved in a violent manner towards them. His
response was “She has a history of violence towards medical
practitioners,” or words to that effect. I told him that I had
known Ms H for 24 years and that this was not true. This led to an
argument between myself and the ambulance driver, terminated when he
wound up the window and refused to communicate with me any further. I
went back inside to find Ms H distressed. She was having difficulty
breathing and it seemed to me to be having an anxiety or panic
attack. “They’re just making it worse,” Ms H said, adding that
she was not going to be ‘shackled’ again and taken by the police
to Hornsby Hospital. I tried to convince her that her health was, at
this point, more important than the embarrassment that a repeat of
the events of 2nd
June would cause – especially since the pains she was experiencing
were the same as she has previously experienced with angina.
I
walked back out into the street and approached the ambulance parked
there to speak with the officer about Ms H’ suspicion that she was
suffering from angina. The ambulance moved up the street, its driver
making it quite clear that he had no intention of communicating with
me. I walked back inside and spoke again to Ms H who told me, firmly,
that this time around she would refuse to be ‘shackled’ in her
own front yard, humiliated in front of her neighbours and transported
to Hornsby Hospital with a police escort. I then called the ambulance
service (at around 11.20) and cancelled the ambulance – making it
quite clear to the operator that this was not because Ms H did not
require treatment but because she did not want a repeat of what had
happened on 2nd.
June. No doubt this conversation will also have been recorded. The
ambulance, that had been parked in the street for the previous 15 -20
or so minutes, drove off.
At
no stage did the ambulance officers get out of the ambulance so could
not have been in a position to have been threatened by her. Could you
please explain to me why it is that the NSW Ambulance Service is
responding in this way to Ms H’ complaint of a severe chest pain?
Was there anything in her behaviour on 2nd
June that indicated Ms H might be suffering from a mental illness;
that she might pose a threat to ambulance officers?
In
relation to 2nd
June I wish to place the following on record and invite the ambulance
officers involved to provide their version of events. You will
appreciate that, as Ms H’ Primary Carer, I can only make informed
decisions as to how best to respond to this new state of affairs
(restraints and police escort) based on the information available to
me. If the information provided to me by Ms H is incorrect in any
way, I need to take this into account. My attempts to acquire
information regarding restraints and police escort from NSW Health
have yielded no result as yet.
On
3rd.
June, at roughly 6pm., I wrote the following to Dr Michael Paton in
an email:
“I
have asked Ms H to put it in writing, but in brief, the Ambulance
refused to take her to hospital without a police esceort and, as I
understand it, a directive has been signed by the Minister that Ms H
must be shackled when she attends any hospital within NSW.is this so?
If it is, could you please explain to me on what grounds it is so?”
Later
on 3rd
June (roughly 7pm) I wrote the following to Dr Paton:
Dear
Michael
Since writing my email to you an hour or so ago I have
had another long conversation with Ms H on the telephone and received
from her a written account of what transpired last night:"Dear
James
I received ur email and would like to confirm with you
that yes indeed Dr peter young did call my employer and had me
terminated from my job as a community care worker. Also last night
2nd June at approx 7pm my daughter called an ambulance as I had chest
pain. The NSW ambalance arrived came inside looked at me and
walked out straight away, stating they would come back. My
daughter recalled the ambulance service who said they should already
be here which they weren't. Some 20 minutes later the ambulace car
number 538 returned in tow with a large number of police over 4
from Manly. I told them I felt humiliated and what if I had died. I
was disgusted. A police constable Chris Williams assisted me to my
feet and took me outside and I was transported and shackled to
the stretcher with restraints. I remained that way the entire time
even while they were doing the ECG. I was taken as directed by
protocol probably set up by Dr Ladd to be taken to Hornsby hospital
whilst there I was seen by a kind female Doctor. A short time
later the mental health Dr a male who asked me two questions..
how was Iand did I have anything I wanted to say to them. Then
he the psychiatrist said ..she's cleared to the Manly police. The
whole saga was humiliating and I believe Dr Ladd and Peter Young were
the persons along with the northern syney central coast area health
executives who had this protocol put in place. The police and
ambulance informed me of this information. I also spoke to the
ambulance service after (Ms H’s daughter) did and said to them this
was inappropriate, and if anything happened to me they were
responsible for walking out and not treating me when they first
came."
(1)
Ms H claims that she knows Dr Young called her employer because her
employer told her that this was the case.
(2) Given that Ms H has
recently had major surgery, why did the ambulance personnel not treat
her immediately when they arrived at her home but left her
untreated?
(3) Who gave instructions to the Ambulance personnel
not to treat Ms H without the police present?
(4) Who called the
police and ask that they accompany the Ambulance to Hornsby
Hospital?
(5) Who instructed the police that Ms H must be
shackled?
(6) Why has this protocol (police escort and shackles)
been implemented as official policy by NSW Health? On what
grounds?
(7) Why was Ms H taken to Hornsby Hospital when there are
several hospitals much close than Hornsby to her home in
Seaforth?
(8) Given that Ms H's was a medical and not a
psychiatric complaint, why was she seen at Hornsby Hospital by a
psychiatrist at all?
(9) If the relevant psychiatrist at Hornsby
Hospital believed that it was necessary to conduct a psychiatric
assessment of Ms Ms H, why did this only involve two questions and,
as I understand it, less than five minutes?
As I mentioned to
you on the phone this afternoon, Ms H has recently had major surgery
at North Shore Private Hospital. During the five or so days that she
was a patient at RNSP, there was not one incident that necessitated
the involvement of the police or of shackles. If you check with the
hospital you will find that they have no cause to complain in any way
at all about her behaviour whilst a patient. It is just as well that
I drove her to and from the hospital. If either of these journeys had
required an ambulance, some variation of what occurred last night
would, no doubt, have occurred - Ms H either being led into or
out of the hospital in shackles with a police escort. This would have
been unfair and humiliating in the extreme and I would like to know
why the NSW Health Service feels that such treatment is
necessary?
Over the past few years Ms H has been in hospital
several times for major operations (one of them the removal of a
Harrington's rod) and on not one occasion has the hospital felt the
need to call the police or to request that she be shackled.
I
am copying this to Ms H because she is an intelligent woman who does
not need me, all of the time, answering questions on her behalf. You
can call her yourself on (phone number) and ask her about the events
of last night. You can then check her version against that of the
police, the Ambulance personnel and staff at Hornsby Hospital. You
can call her yourself and ask her about Dr Young's phone call to her
employer. Even before calling Ms H's former employer you can ask Dr
Young if he did in fact call her, why he called her and what he said?
You can call Ms H yourself and ask her what on her file is true, in
her opinion, and what is untrue. In the instances where she tells you
such and such is untrue you need not, of course, take her word for
it. However, it is your responsibility to find some reliable source
for the information or else expunge it from the file - especially
allegations such as 'attempted murder'. I know from experience that
there is a good deal that is on file that is nothing more than
hearsay. Much of this hearsay has to do with incidents concerning
guns and knives and other acts of violence that never occurred. When
asked in a Tribunal hearing for evidence of these acts of violence Dr
Ladd told the Tribunal that the file had gone missing!
All the
evidence available to me suggests that Dr Ladd and Dr Young are
determined to provoke Ms H into an act of violence that will,
retrospectively, provide justification for the shackles, for the
police escorts. Given what occurred last night, it can come as no
surprise to you that Ms H has no faith in the services you supposedly
have on offer to help her through her next crisis. It should come as
no surprise to you that as a result of what occurred last night that
Ms H is, for the first time since she left Hornsby Hospital, deeply
depressed. If Ms H had been suffering from a psychiatric illness last
night, would it surprise you if she had reacted angrily to being
treated in such a humiliating way? The function of the NSW
Health Service is to help people like Ms H in times of crisis - not
to create such crises with the sort of behaviour that was on display
last night - shackles and a police escort for a woman suffering not
from a psychiatric condition but from severe chest pains.
I
would appreciate your prompt attention to this complaint - along with
answers to the questions I have raised.
best wishes
On
6th
June I received an email from Dr Paton which reads:
“thanks
James for bringing this to my attention. When we spoke I was not
aware of this issue - clearly this is an unintended and serious
consequence of the current management plan, and as her clinical
circumstances have changed we need to revise the plan - physical
health care considerations need to be considered also.
I will
look into this today as a prioroty today – thanks”
I
responded to Dr Paton on 6th
June with an email in which I wrote:
“When we spoke early in the
afternoon of 3rd.
June I was unaware of the incident that had occurred the night
beforehand that resulted in Ms H’s being taken in an ambulance, in
restraints, against her will and with a police escort, to Hornsby
Hospital. When I discovered this, within minutes of speaking with
you, I wondered, needless to say, if you were aware that this
incident had occurred when we spoke on the phone. I accept that you
did not know of it – which raises the question: How could you NOT
know of an aspect of Ms H’s Case management Plan that involves such
draconian measures – restraints and a police escort?
At no stage, in my conversations
with you, Dr Drew, Dr Meladonis and ‘Dr Archer’ had there been
any mention of a Case Management Plan that forbad ambulance officers
from entering Ms H’s home, that necessitated the presence of the
police and Ms H’s being restrained. And this was not occurring
whilst Ms H was in the midst of a ‘crisis’ requiring psychiatric
intervention but when she was merely suffering severe chest pains!
Even if she had been suffering from a mental illness last Thursday
night, what grounds does NSW Health have for implementing such a
protocol?
I cannot find the words to
express how wrong it is, on so many levels, to treat Ms H in this
way. If her severe chest pain had been the result of a heart
condition who knows what the outcome might have been as a result of
her not receiving appropriate treatment from the time that the
ambulance first arrived at her home and the time that the police had
come and removed her from the house. It would seem, from Ms H’s
description, that up to half an hour had elapsed. The ambulance and
police records will reveal precisely how much time Ms H went
untreated but even if it was only 15 minutes, in the case of a
serious heart condition, this 15 minutes could mean the difference
between life and death – the awful dilemma that Mr T now finds
himself confronted by if he should have a stroke today.
It would seem, from Ms H’s
account and from that of her daughter, that as Ms H was being put
into restraints, in front of her house, the entire yard was
illuminated by lights from either the ambulance or police cars or
both. The accuracy of Ms H and (daughter’s) recollections can be
checked against what the police and ambulance officers recollect. If
true, Ms H’s pain in the chest has resulted in her neighbours being
witness to an occurrence that would appear to be: Ms H’s being
arrested by the police, restrained and put into an ambulance. There
is no interpretation of such a scene that I can think of that does
not reflect badly of Ms H’s character. The actions on the part of
the ambulance officers and police constitute public humiliation for
Ms H. How does she explain what occurred to her neighbours?
Clearly, neither the ambulance
officer or the police are responsible for this humiliating spectacle.
NSW Health is responsible. To be more specific, the Case Management
Plan implemented by NSW Health is responsible – a Case Management
Plan that you seem to be unaware of; a Case Management Plan that I
was unaware of – despite many requests for its details. The
question that arises, and it is one I want an answer to: Why was this
aspect of a Case Management Plan put in place in the first place and
by whom? What incidents can those who implemented this Case
Management Plan point to, to warrant restraints and a police escort?
The list of things wrong with
what occurred goes on. When Ms H became aware that she was to be put
into restraints and taken with a police escort to Hornsby Hospital
she told the police that she did not want to go under these
circumstances. Given that she was not under arrest and not suffering
from a mental illness, why was she forcibly taken to Hornsby Hospital
when both Manly Hospital and Royal North Shore are much much closer?
Ms H claims that the only explanation given to her was that it was a
‘protocol’ that had been signed by the Minister for Health. Is
this so?
Ms H describes what occurred in
relation to her ‘consent’ in the following words:
“I said to Chris Williams,
cop from Manly, and the two female drivers over 10 times that I
did not want to go when I was lying on my couch. I told Chris
Williams this. I said it was humiliating. The police kept saying u
should go. I also continued to tell them whilst they were restraining
me on the trolley outside my house and in the ambulance that I did
not want to go. I was persisitent but I was forced to go under
duress. The police said do it for your daughter; she's
called the ambulance. I did NOT want to go because I knew they we're
going to restrain me. I also kept asking at the hospital to the
female ambulance driver I wanted to discharge myself. I was scared
and embarrassed. She told me under NSW protocols I have to stay.
The ambulance driver kept saying we're going in circles and that they
we're only doing what they we're told.”
Ms H’s description of what
happened, if it is accurate (this can easily be checked with the
police and ambulance officers) raises questions as to the legality of
what took place!
It would seem, after being given
an ECG and having her blood pressure taken at Hornsby, that Ms H was
attended by two people who identified themselves as mental health
workers. After asking her a couple of perfunctory questions they left
the room to speak with someone on the phone. When they returned, Ms H
was told that she was cleared to go! What does this mean? Who had
‘cleared’ her? She was at Hornsby for medical and not
psychiatric reasons. Why was the issue of her being ‘cleared’
even raised?
Michael, I have by no means
exhausted the questions that arise for me in relation to this matter
but other commitments prevent me from writing more at the present
time. I have not, for instance, made any reference to the phone call
made by Dr Young that resulted in Ms H losing her job. I trust that
you will request of Dr Young that he confirm or deny, in writing,
that he made such a phone call to Ms H’s employer.
At your earliest possible
convenience Ms H and I would like to come and talk with you. We would
like to show you the DVD – which will raise many of the questions
that need to be discussed.
best wishes
I
have not received any further correspondence from Dr Paton and it is
clear from the events of last night (8th
June) that ‘the current management plan’ still precludes
ambulance officers from entering Ms H’s home; that the ‘the
current management plan’ still necessitates that the police remove
Ms H from her home and place her in restraints in the event of a
medical emergency.
If
you have any information at all regarding assaults by Ms H on
ambulance officers (or threats of assault) could you please let me
know when and where these occurred? If the information that Ms H has
provided me with in this regard is wrong, I would like to know.
Under
the NSW Ambulance Facts Sheets Issued July 2009 is to be found the
following:
“Paramedics
have a duty of care to the public to ensure appropriate clinical
treatment is provided. Refusing treatment and/or transport,
paramedics will not transport you to hospital against your will.”
Given
that Ms H indicated many times to the ambulance officers on 2nd.
June that she did not wish to be taken to Hornsby Hospital under
these circumstances (restraints and police escort) could you please
explain on whose authority she was, in fact, transported against her
will? It seems to me that the Ambulance Service is in the invidious
position of being obliged to obey a directive without any
understanding of why the directive has been implemented.
Alternatively, the Ambulance Service is aware of why the protocol is
in place but neither myself nor Ms H is allowed to know the wording
of it (to be found in Ms H’ ‘current
management plan’ or
the reason for it.
I
now find myself in the position of living on a full-time basis in Ms
H home dealing with the consequences of this aspect of Ms H’ Case
Management Plan’ – a ‘Plan’ that has been implemented without
any consultation with either myself or Ms H. My many attempts to
acquire a copy of this ‘Plan’ from NSW Health have yielded no
response.
Could
you please let me know, today, what protocols cover Mr T, who lives
in Ms H home? In the event that there is a medical emergency
involving Mr T (a diabetic who has had two strokes since last Nov.),
will attending ambulance officers have to await the arrival of the
police before they can treat him? All the indications are (and these
you can check with your own records) that the time that elapsed, on
2nd.
June, between the first phone call to the ambulance operator and the
arrival of the police was between 35 and 40 minutes. A delay of this
kind could prove fatal to Mr T.
I
have enclosed, for your interest, a copy of the letter that I sent to
Dr Paton dated 8th
June in relation to this matter so that you may be acquainted with as
much information as I am. I am also copying this letter to Dr Paton
in hopes that this matter can be resolved as quickly as possible.
best
wishes
James
Ricketson
cc
Dr Michael Paton
