Royal Hobart Hospital sitter was looking at mobile phone when man had fatal fall: Coroner

A coroner has cleared Royal Hobart Hospital staff of blame after a man died from a fall in a ward corridor, while his sitter was looking at her mobile phone. Why she said her eyes were on her device.

Royal Hobart Hospital

A coroner has cleared Royal Hobart Hospital staff of blame after a man died from falling and hitting his head in a ward corridor while his sitter was looking at her mobile phone.

In his findings handed down on Wednesday, Coroner Robert Webster said 75-year-old Peter Harris died in May 2020 from a head injury caused by the fall, and pneumonia developed while he was in palliative care.

Mr Harris was taken to hospital by ambulance on April 30 that year with possible delirium, behavioural disturbances and low sodium levels.

A few days later on May 4, while still in hospital, Mr Harris fell backwards from a standing position, suffering extensive skull fractures.

He passed away five days later.

Forensic pathologist Christopher Lawrence found it was likely Mr Harris’ fall was caused by his low sodium levels, and that he died of pneumonia while receiving palliative care for his fatal head injuries.

A coronial medical consultant, Anthony Bell, reviewed the case after Mr Harris’ family raised concerns about his care in hospital.

Dr Bell said his fall was a sudden and unexpected event – but unlike Dr Lawrence, found the fall likely had a cardiac origin, rather than being caused by the low sodium levels.

Mr Webster noted Mr Harris had been assessed as low risk for falls.

A sitter tasked to keep an eye on him said he fell suddenly while wandering the ward and “without any indications”, while she was checking the time on her phone.

“However that did not distract me as I was still focused on Mr Harris. He fell without any warning and there was nothing I could do to stop his fall,” the sitter said in a statement.

The coroner said he “very carefully” reviewed CCTV footage of Mr Harris’ fall.

“It seems to me (the sitter) is looking at her phone for longer than would be necessary to check the time. Further her use of her mobile telephone breached the responsibilities of a patient safety observer,” Mr Webster said.

“Having said that, I note Mr Harris fell very suddenly and without warning, after which (the sitter) moved very quickly. It is unlikely she could have prevented Mr Harris from falling even if she was not using her phone.”

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