Health and Community Services Complaints Commission Report on Investigation of Royal Darwin Hospital Security Arrangements for the protection of Children and Infants Paediatric Ward 5B Volume 1
Tabled paper 163
Tabled Papers for 11th Assembly 2008 - 2012; Tabled Papers; ParliamentNT
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6. EXECUTIVE SUMMARY Scope of Investigation On 30th March 2006 a five month old female infant was raped while an inpatient in the Paediatric Ward 5B at RDH. The Health and Community Services Complaints Commission investigated the arrangements in place at Ward 5B for the protection of patients as well as any action taken by RDH in response to the severity of the incident. Conclusions of the Commissioner 1. On 30th March 2006: There were no arrangements in place on the Paediatric Ward to ensure the safety and inviolability of vulnerable patients. No risk assessment had been conducted. The arrangements in place did not comply in any aspect with the Australian Standard which sets the benchmark for proper security. There was no control on access to the Ward or to the patients. The staff had not received adequate training, and possibly none at all, about the risks arising from lack of security arrangements. In 2002 RDH had commissioned and received an expert consultants assessment and report on security arrangements at RDH. The Terms of Reference did not require 5B to be assessed. By 30 March 2006 the recommendations in the report had not been implemented in Ward 5B. This failure can only be described as shameful. Following the rape of the infant police were not notified for about 2 hours. 2. Action taken by RDH after the rape to improve security was: (a) slow (b) inadequate, and (c) has not been adequately evaluated or reviewed to determine its effectiveness 3. RDH has a Security Manager on site as well as an NT Police member stationed at the hospital. Neither has been asked to evaluate the security on the Paediatric Ward either before or after the rape of the infant. 4. Staff working on the Paediatric Ward have not been trained at their induction on the elements of security arrangements to reduce the risk to vulnerable patients nor has there been adequate ongoing training of staff before or after the 30th March 2006 incident. 5. In 2007 the same expert safety and security consultant, as in 2002, was engaged to assess security arrangements at RDH. He was not informed of the rape of the infant in March 2006 nor was he asked to report specifically on arrangements in the Paediatric Ward. 6. On 21 November 2007 two investigation officers from the Health and Community Services Complaints Commission visited the Paediatric Ward by prior arrangement. They were able to enter the Ward and wander around, have entry to every part of it and stand at the nurses station, for about 25 minutes without anyone asking who they were and why they were there. 7. Managements lack of commitment to the proactive identification of risks and to taking appropriate action has not created a culture where each member of staff