Compensation for restraint in A&E
I recently settled a claim for a young lady who suffered injuries as a result of alleged negligent treatment in a well-known London hospital’s A&E department.
My client had been experiencing symptoms including auditory hallucinations and paranoia for about two weeks and her worried father took her to A&E late at night. She was assessed by two doctors and told them that she did not feel safe. At first, she was calm and cooperative.
The doctors assessed my client under section 2 of the Mental Health Act and it was concluded that she needed to be admitted to hospital. One of them discussed this decision with my client and her father. She began pacing and shouting that she did not feel safe. There happened to be two police officers in the A&E department at the time and they helped return my client to the psychiatric assessment room where she calmed down.
At some point during this time a member of staff had contacted the trust’s ‘Rapid Response Team’ (RRT) and asked them to attend.
Having calmed down, my client was sitting calmly in the assessment room, trying to remove a cannula from her arm. The RRT then arrived (consisting of 6 adults). They entered the assessment room and proceeded to restrain her. She became increasingly agitated and struggled as the RRT intervened. She managed to move the group of people from the assessment room into a nearby office through a connecting door.
Once in the office, the RRT forcibly restrained my client on the floor, face down. She was extremely distressed. The restraint continued like this for 2 hours.
At some point a pillow was placed on the floor under my client’s face – she struggled to breathe. She suffered multiple cuts, bruises and carpet burns to her face and body.
My client has been left with some residual scarring and is particularly bothered by the marks on her face as well as an increase to the severity of her psychotic episode as a result of the restraint and she now suffers from situational anxiety.
My client went through the hospital complaints process. The hospital denied any failings in her treatment. I prepared a detailed letter of claim and sent this to the trust with some early settlement proposals. A letter of response came from the NHS Litigation Authority still firmly denying any breach of the duty of care the trust owed to her.
It wasn’t until court proceedings were issued and served that solicitors were instructed on behalf of the trust. Those solicitors requested an extension of time for service of the Defence during which I understand they sought evidence from a control and restraint expert.
Shortly before the Defence was due to be served the trust’s solicitors made an offer to settle and after a short period of negotiation my client accepted an offer to settle in excess of the initial amount she had been prepared to accept when the claim was first put to the Trust.
My client is small in stature. At the time of the incident she was a child. The control and restraint expert I instructed on her behalf told me that in his view it was simply unacceptable that six adults could restrain a child face down for two hours without having the necessary skill or expertise to calm her down or diffuse or de-escalate the situation. He identified six areas in which he believed her care fell below an acceptable standard:
“(a) there was no proper or adequate attempt to de-escalate the incident and/or deal with it in a different way before the Claimant was restrained
(b) in any event, the Claimant should not have been restrained in the prone position
(c) the restraint, even if necessary, went on for far too long
(d) the restraint, even if necessary, appears to have been carried out poorly, heavy-handedly and with excessive force (especially given that the Claimant was small in stature and there were six members of a trained RRT) and/or without the skills that ought to have been deployed to render it as safe as it could have been in the circumstances
(e) six adequately trained members of a RRT ought to have been able safely to restrain a 17-year-old woman who is somewhat small in stature and to administer a prescribed dose of Lorazepam
(f) the Claimant’s treatment fell below an acceptable or reasonable standard and this resulted in the physical injuries she sustained. I am not competent to comment on any psychological injuries and have not done so”
This was a very sad case but my client is pleased that it has at last been recognised that her treatment was not acceptable.