Australia: Emergency Department Medical Malpractice Cases

Health Law Bulletin
Last Updated: 18 November 2010
Article by Alison Choy Flannigan
This article is part of a series: Click Copyright in health records for the previous article.

There have been a number of recent cases relevant to emergency departments. This article briefly summarises some of the relevant cases and draws from them lessons to be learned.

Unacceptable delay

On 5/6 March 2006 Aileen Dawn Promnitz, a 79 year old resident at St Hilarion Nursing Home at Lockleys, was conveyed by ambulance to the Queen Elizabeth Hospital because of dehydration resulting from the deterioration in her health. She was triaged as Priority 4 and, according to the Australian Triage Scale, should have been seen by a doctor within one hour. Unfortunately, she was left for six hours on a trolley in a corner of the Emergency Department waiting room without being seen by a medical practitioner, where she remained until a member of the public found her to be deceased. During that time, she was seen twice by a nurse and on both occasions her vital signs were normal.

The Coroner found in his report dated 3 June 20101 that Mrs Promnitz's death (a result of sepsis due to a urinary tract infection) was avoidable and the support for nursing home patients by general practitioners in South Australia was inadequate.

The Hospital made the following changes to reduce mortality arising from overcrowding:

  • There is now a nurse in the Emergency Department whose role it is to assist the triage nurse. This assistant is assigned solely to maintain contact with patients in the waiting room and ensure that they are observed.
  • There is now a formalised over-capacity policy, which means that the ED can call a 'Code E' across the hospital to signal to other parts of the Hospital that they require assistance. At this call all senior medical staff and consultants within the hospital are required to assess existing patients for discharge and critically determine whether any capacity exists for the transfer of patients from within the ED to medical wards. Triggers include where there are more than 45 patients in the ED, or where there are 35 patients but also 10 awaiting admission, and where there is a patient in category 2 who has been waiting for over 30 minutes.
  • A new ward has been added to this hospital which is calledthe Diagnostic and Planning Unit.

The strategies introduced by the Queen Elizabeth Hospital may be helpful for other health care facilities currently attempting to reduce access block in their ED's orsuccessfully implement the 4-Hour Rule.

Emergency Room miscarriage

On 25 September 2007 Jana Horska miscarried in the toilet of Royal North Shore Hospital's emergency room. Jana was triaged as Priority 4, that is, a patient with a potentially serious condition, to be treated within one hour. The level of activity in the Emergency Department that night was extremely high. Despite complaining of acute pain, she did not receive medical treatment within one hour and miscarried after two hours of acute pain. Her partner Mark Dreyer complained to emergency staff but was repeatedly told to sit down and wait. His wife had already had a miscarriage that year.

Professors Clifford Hughes and William Waters investigated the case and recommended a new protocol for the treatment of women presenting at Emergency Departments with threatened miscarriages. The recommendations included:

  • women who arrive at hospital displaying signs of a complication in early pregnancy, and whose condition is assessed as unstable are now placed in a higher triage category; and
  • the Emergency Department at Royal North Shore Hospital should be changed to improve the experience of patients: changes to the physical environment of the waiting room, improvements in communication skills of frontline triage nurses and the provision of written information to patients on how emergency departments work.

Multiple errors and omissions - Lack of communication and inadequate medical notes

Vanessa Anderson was a 16 year old girl who tragically died at Royal North Shore Hospital after being admitted with a head injury inflicted by a golf ball.

The State Coroner found that there was poor communication between her doctors, staffing inadequacies, no or inadequate medical notes, poor clinical decisions, ignorance of protocols and incorrect decisions made by nursing staff.2

Ultimately, Vanessa's cause of death was found to be from a respiratory arrest due to the depressant effect of opiate medication. She had been given four times the therapeutic dose of opiate analgesia after her anaesthetist misread her medication chart. However, one of the initial short fallings of the hospital that resulted in her death was that the on call consultant neurosurgeon was not told that Vanessa had been admitted to the ward under his care.

In addition, Vanessa's attending senior resident doctor, a Dr Nicole Williams, had omitted to write the word 'or' between two analgesics she had prescribed in the alternate for Vanessa. On 18 December 2009 Dr Williams was found by the NSW Professional Standards Committee to be guilty of unsatisfactory professional conduct relating to the requirement to keep proper medical records (including concerning the medication order of parenteral morphine).3

1. South Australia, State Coroner, Aileen Dawn Promnitz - finding of inquest, 3 June 2010.

2. New South Wales, State Coroner, Inquest into the death of Vanessa Anderson, 24 January 2008.

3. New South Wales, Professional Standards Committee Inquiry, Inquiry into a complaint in relation to Dr Nicole Williams, 18 December 2009

© DLA Phillips Fox

DLA Phillips Fox is one of the largest legal firms in Australasia and a member of DLA Piper Group, an alliance of independent legal practices. It is a separate and distinct legal entity. For more information visit

This publication is intended as a first point of reference and should not be relied on as a substitute for professional advice. Specialist legal advice should always be sought in relation to any particular circumstances.

To print this article, all you need is to be registered on

Click to Login as an existing user or Register so you can print this article.

This article is part of a series: Click Copyright in health records for the previous article.
This article is part of a series: Click Recent developments in embryonic stem cell research and biological therapies for the next article.
Some comments from our readers…
“The articles are extremely timely and highly applicable”
“I often find critical information not available elsewhere”
“As in-house counsel, Mondaq’s service is of great value”

Mondaq Advice Centre (MACs)
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at and we will use commercially reasonable efforts to determine and correct the problem promptly.