A Tasmanian man’s fall in the corridors of the Royal Hobart Hospital in 2020 has been confirmed as a partial cause of his death, according to a coroner’s investigation to determine whether a public inquest was required.
Peter Harris, 75, was under the watch of a hospital-employed sitter who had her eyes on her mobile phone when he sustained the fatal injuries.
The grandfather — who was an avid bush walker, viola player, and retired architect and woodworker — had begun obsessing over certain topics in the weeks before his family called an ambulance. His wife said he was otherwise “perfectly fine”.
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But he became “very agitated” at home on May 1, 2020, in a state that doctors initially believed was delirium, possibly caused by low sodium levels in his blood.
Police placed Harris into an ambulance under the Mental Health Act 2013, and he was taken to hospital, where it was decided he should be admitted for further testing.
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Four days later, Harris — who had been assessed as low risk for falls — was wandering the hospital corridors, unable to be convinced to stay in his room, the coroner’s report said.
“(His sitter) was required to follow him around, distract him, re-orientate him or redirect him if he, for example, entered other patients’ rooms,” Coroner Robert Webster reported. “This she did.”
But the casual staff member, who had been working for the hospital for three years, was looking at her mobile phone when Harris fell backwards at 8.45pm.
Webster determined the sitter was looking at her phone longer than was required, and said: “Her use of her mobile telephone breached the responsibilities of a patient safety observer.”
But Webster also said Harris “fell without warning,” noting the sitter moved towards Harris as he began to fall and “it is unlikely she could have prevented Harris from falling, even if she was not using her phone”.
“Harris was a taller person than (his sitter) so even if she was able to grab a hold of him prior to him hitting the floor, it is unlikely she would have been able to lessen the impact of the fall.”
The Royal Hobart Hospital and its staff have been cleared of blame after a man’s fatal fall in their care. Credit: AAP Images
Scans found extensive skull fractures and bleeding in the brain, and Harris was transferred to ICU.
He died five days later, on May 6.
“Harris died as a result of pneumonia, the onset of which occurred after he received palliative care after he suffered a head injury in a fall,” Webster said.
Despite a number of questions from Harris’ family regarding his care and treatment, Webster stated: “The circumstances of the death of Peter Harris raise the question as to whether or not a coroner is required to hold a public inquest into his death — the short answer is no.”
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