The Correctional Services Department has confirmed the woman – a prisoner – was transferred to the Lyell McEwin Hospital last Friday, after an inpatient treatment order under the Mental Health Act.
A spokesperson said she was “restrained in line with protocols under the Correctional Services Act” until she was admitted to forensic mental health facility James Nash House on Monday.
The case has come to light despite repeated red flags raised by at least two state ombudsmen over several years about the use of restraints in hospitals.
They have cited examples including a young man who was made to wear nappies while shackled to a bed at the Royal Adelaide Hospital for five days and a 53-year-old lung disease patient shackled to her wheelchair while she went to the toilet.
Dr David Pope, an emergency doctor at the Lyell McEwin and president of the SA Salaried Medical Officers Association, told InDaily in the latest case the young woman was handcuffed to a bed in a cubicle of the ED for the duration of her stay.
“She was waiting for a bed at James Nash House and in lieu of that she was chained to a bed in the ED… guarded by prison officers,” he said.
“The issue there is spending that amount of time in an ED while being chained up.
“It does affect us operationally in terms of wait times for other patients because you have the cubicle space taken up but it’s also a human rights issue – for that length of time you have got someone chained to a bed.”
Dr Mark Morphett, chair of the SA faculty of the Australasian College for Emergency Medicine, said it was “certainly not the care that anyone would want for any of their relatives”.
“I’m not entirely convinced that we can in any great way justify handcuffing someone to a bed for three days – that seems horrible,” he said.
Chief Psychiatrist Dr John Brayley has confirmed to InDaily he has been investigating other hospital emergency departments in recent months, after issuing the Royal Adelaide Hospital with an intervention order earlier this year for its use of restraints on mental health patients and a lack of reporting.
“Yes, we have been systematically going to different EDs with our inspections and also reviewing data from EDs,” he said.
“We are in the early phases of having discussions with another service about a similar issue.”
When asked if that meant there was another ED where he had concerns about these practices he said: “There is.”
He declined to name the hospital or elaborate, saying: “At this stage we’ve put those concerns to the relevant LHN (local health network) and we’re waiting for their response to the data and other factors.”
“You might recall with the Royal Adelaide there had been quite a process before we got to the point of gazettal (his intervention). It had started literally in early January of this year,” he said.
Brayley also added that he had seen examples of “both good practice and very good practice in terms of reporting at other EDs”.
“In 2021 we expect to have a benchmarking system in place so that the reporting across EDs can be clearly described,” he said.
InDaily asked SA Health which hospital Brayley was referring to and whether he could provide more information.
A spokesperson said Brayley expected to provide an update “early in the new year and respond to questions then”.
“The office has received a detailed response from that service about work underway and is analysing the impact of that work,” the spokesperson said.
Regarding the recent case at the Lyell McEwin, the Correctional Services Department spokesperson said once the department had conveyed a prisoner to hospital under the Mental Health Act, “it is a Health decision to admit to an inpatient mental health bed”.
“The safety of the community and staff in a public area such as a hospital is of paramount importance to (the department),” the spokesperson said.
Morphett said the case was “another example of forensic mental health being a really specific touchpoint where there’s significant stress and where the bed capacity and the bed use for James Nash needs to be looked at”.
He was unaware which ED the Chief Psychiatrist had concerns about but said the use of physical and chemical restraints in South Australian hospitals generally “is not a new problem but it’s a problem that we need to continue to urgently address”.
“Our goal for that should be zero,” he said.
“Those things need to be seen as the last option when there are no other options.
“One of the problems is the flow of our mental health patients through emergency departments is delayed and then you have a patient who’s in crisis who then has this hyper-stimulating environment and so if we get patients to the right place we won’t have to chemically and physically restrain them as much.”
Asked about the recent Lyell McEwin case, an SA Health spokesperson said: “While we are unable to provide comment on specific cases, there are times when a forensic patient/prisoner may be transferred from a prison on an inpatient treatment order for admission to a mental health facility.”
The spokesperson said forensic patients and prisoners would undergo a security assessment as part of any transfer process “and we abide by the security instructions of Corrections Officers with regards to prisoners brought to hospital for treatment, while advocating on behalf of the patient for appropriate care arrangements”.
“We acknowledge there can be high demand for forensic mental health beds – particularly for high-risk offenders – who may only be suitable to be transferred to a particular facility,” the spokesperson said.
“A number of measures are being put in place to stem the flow from prison and the courts and to facilitate more rapid admission to James Nash House including a court diversion program.”
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