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Paramedic hits back at Govt over disability neglect case

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EXCLUSIVE: A paramedic who treated a man at the centre of a state government disability neglect case says she was “shocked” at the “Third World” condition she found him in, after Human Services Minister Michelle Lensink today suggested first responders had reached “some of their own conclusions” .

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The paramedic told InDaily the man was “absolutely” in a state of neglect, wearing dirty clothing and soiled underwear.

“I would say that his treatment was clearly sub-par for his needs,” she said.

“I would say that basic human rights of being able to be clean and having adequate wound management weren’t there. He would have been in pain.

“To see a person in that state that was there, in order to receive care to be left and seemingly forgotten about… one of the things I found particularly concerning was the fact that he had a dirty wet flannel on his open wound on his jaw which had food on it.

“It smelt Third World to be honest. The way he was left looked like something you would see in the Third World.”

The paramedic, who asked not to be named, spoke to InDaily after Lensink defended the hygiene and nutrition care provided to the man, telling ABC Radio Adelaide that ambulance officers who reported finding him wearing soiled clothing and underwear before rushing him to hospital with an infected wound had reached “some of their own conclusions”.

Publicly addressing the matter properly for the first time since an independent inquiry four weeks ago found “serious failings” in the man’s care at Hampstead Rehabilitation Centre, Lensink said that “some of the language that has been used has been inflamed for whatever purposes”.

The paramedic hit back, saying the man’s family “was really concerned about him” and “I was shocked at the state he was in”.

“And the communication surrounding his care was often contradictory,” she said.

“The people that were caring for him couldn’t answer a question clearly, couldn’t provide a professional handover and didn’t understand or could communicate basic clinical findings and treatment pathways of his presentation, of his wound.”

The case was first revealed by InDaily last year, after the man was rushed to hospital from the Transition to Home (T2H) care service run by the Department of Human Services (DHS) at Hampstead Rehabilitation Centre.

Paramedics and doctors were so concerned about his condition they lodged complaints of alleged neglect.

After a lengthy investigation, the independent health watchdog on February 14 released his findings, condemning “failings in hygiene, wound care and weight management and how they led to a situation that should have been avoided”.

“I am disappointed that the care of a consumer living with a disability is again under scrutiny,” Health and Community Services Complaints Commissioner Associate Professor Grant Davies said at the time.

In his report, Davies said the SA Ambulance Service (SAAS) crew noted concerns about the care of the man – referred to as Mr D – including “that he had an infected pressure wound, that he was wearing dirty clothing and that he had malodourous body odour”.

The case drew comparisons with the horrific neglect death of Ann Marie Smith who died in hospital in 2020 of septic shock and organ failure after allegedly being left to sit in a cane chair for a year.

After refusing multiple requests for media interviews on the matter since the report was handed down, Lensink today was asked about the issue during an ABC Radio Adelaide interview about International Women’s Day.

When asked why Mr D had been found sitting in his own urine and faeces, Lensink said: “I think if people read that report in detail they will appreciate the circumstances that Mr D had daily bed baths and changes and indeed the day on which the ambulance service arrived it was reported he had a fresh shirt.”

“He’d seen a GP and a registered nurse in the days leading up to that particular episode where he needed to be taken by ambulance,” she said.

“I think the comparisons that have been drawn are unfair in relation to the Ann Marie Smith case. Mr D was a very different situation. He had people around him. He was attended to daily but obviously there was things the service missed and so we have apologised.”

Asked if ambulance officers who were concerned about his condition overestimated the situation, Lensink said: “They also used terms like ‘apparent neglect’.”

“They didn’t have access to all of his records, all of his history which the Commissioner did and the Commissioner made no finding of neglect,” she said.

“They saw Mr D at a single point in time. I think they reached some of their own conclusions. The Commissioner had the full benefit of all of the records and made different findings.”

The paramedic is furious at Lensink’s comments, describing them as “really upsetting.”

“His clothing was categorically soiled,” she told InDaily.

“That was confirmed by family as well that they had been concerned with the clothing that he was in and often not even in his own clothing, in other people’s dirty clothing.

“The shirt that he was wearing was absolutely not clean. Absolutely not. The shirt he was wearing had pus and food and dried skin on it.”

She said his smell was “significantly odorous” and that she “absolutely” stood by her comments.

“I have absolutely no interest in fabricating or overestimating anything about my patients’ state,” she told InDaily.

“My job is to treat patients and to make sure that they’re receiving the care that they want.”

She said the Minister “wasn’t in that room and I’m sure that the family would disagree with her as well”.

She maintained it appeared as though he had not been bathed in recent days, despite records showing otherwise, “and he did not smell as if he had either, poor man”.

“We are mandated reporters, it is our job to advocate for our patients,” the paramedic said.

“This was a patient that quite obviously needed that advocating because he couldn’t advocate for himself and the family was trying to advocate for him and getting nowhere.

“My job as a paramedic is to advocate for the wellbeing of patients and that’s exactly what I’ve done, and my partner.

“To be accused of making more of a deal out of it than perhaps we should have is shocking.

“As a paramedic who is trained in pre-hospital care, who is trained in medicine, I feel quite maligned that someone would say that I was incorrect. I don’t think a politician knows much about wounds. I don’t think she’s in the right position to actually make those statements.

“He was certainly not in clean clothing and we asked him to be put in clean clothing. He had not had his undergarments changed. His shirt was absolutely not clean and it wasn’t his shirt, it was another patient’s according to his family.”

In his report, Davies said SAAS received a triple zero call on May 31 regarding Mr D “who had increased drowsiness and was not responsive”.

On arrival, they found the man with an infected pressure wound, with patient clinical records stating: “SAAS staff found patient with dirty clothing (had not been changed for a few days). Malodourous body odour and poor personal hygiene due to the negligence of carers.”

“Patient’s case worker and sister report patient has been found in this state (left in faeces and urine (for) prolonged periods of time, with a dirty moist towel over infected wound site),” the notes said.

“SAAS staff also found the wound care of the RN (registered nurse) to be neglectful and subpar…”

Lensink this morning said it was “absolutely not correct” to say the man had been found left sitting in faeces and urine for “days”.

“I think it’s worth bearing in mind that people who are heavily incontinent, there will be times when they will have urine and faeces but they need to be cleaned up,” she said.

Asked how long Mr D had been left sitting in it, Lensink said “it would have been a matter of a short time because he was checked and cleaned daily”.

“If somebody had been sitting for prolonged periods in their own faeces there would have been burns and faecal tears, skin tears.

“There was no evidence of any of that.”

Lensink pointed to the section of the Commissioner’s report which includes a record from the facility showing Mr D had received daily baths, although the Commissioner noted there were a few days with no such record.

In his findings, Davies said the man weighed 57 kilograms – “below his identified healthy weight range” – when he was weighed at the Royal Adelaide Hospital on June 3.

“When SAAS officers attended T2H on 31 May 2021, they thought Mr D appeared to be malnourished,” he said.

“DHS acknowledges that T2H could have done more to monitor Mr D’s weight and agrees that his weight loss contributed to him being a high risk of malnutrition.”

The Commissioner made 13 recommendations including that T2H “apologise to the man and his family for the inadequate care he received”.

He also recommended that hygiene and care be assessed on admission to T2H for all patients, and checked regularly throughout their stay.

Lensink said “we and the Commissioner all reached the conclusion that Mr D was probably too complex for the service at the time of his admission because there were a range of factors”.

“He had a wound and therefore required nursing care and the service hasn’t been a health service, it’s a disability service,” she said.

“We also respect the rights of people with disabilities so Mr D had refused a number of things including washing and trimming of beard, showers and the likes.

“So, as a human rights based service, DHS very much respected the wishes of this patient.  What we have done is put in that oversight in terms of that level of clinical care which wasn’t envisaged when we set the service up and so that is in place so people will get assessed within 48 hours of their admission … if they have any ongoing nursing needs, as Mr D had, then they will be looked after.”

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