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Based on this case study, identify and discuss the ethical..

Based on this case study, identify and discuss the ethical principles and legal principles related to this case study.


The complaint relates to the attendance by the Nurse to a patient (“the Patient”) in the Emergency Department of Maclean District Hospital (“Maclean Hospital”) on 23 December 2009. At this time, the Nurse was employed as a Clinical Nurse Specialist (“CNS”) working in the Emergency and General Ward Areas of the Maclean Hospital. On the night in question, the Nurse was undertaking triage duties in the hospital. Maclean Hospital is a rural hospital in the Northern Area Health Service. No doctors were physically present within the hospital at times relevant to this complaint.


It is alleged that at approximately 8pm, the Patient attended the Emergency Department of Maclean Hospital and was attended to by the Nurse (“the consultation”). At the consultation, the Patient indicated to the Nurse that he had experienced pain in his left calf whilst in the surf that afternoon. The Nurse performed some examinations and observed that the Patient’s leg was dusky in colour and that no pedal pulse was present.


The Patient informed the Nurse that he had undergone femoral-popliteal bypass surgery some years prior to the consultation and that his vascular surgeon had been unable to detect a pedal pulse in consultation three weeks prior. There is a dispute as to exactly what observations were made by the Nurse and whether the Nurse gave the Patient two Panadeine Forte tablets, observed him for 20 minutes, and then discharged him after he said that his pain level had decreased. The precise discussions between the Nurse and the Patient are also disputed. It is clear, however, that the Nurse ultimately gave the Patient a box of Panadeine Forte before he left the hospital.


The Patient returned to Maclean Hospital on the afternoon of the following day (24 December 2009) and was seen by a doctor who reiterated the Nurse’s advice to take Panadeine Forte to control the pain. A further doctor was contacted by telephone on 26 December 2009. On 27 December 2009, the Patient’s condition deteriorated, causing him to be returned to Maclean Hospital by ambulance. The Patient was transferred to Lismore Base Hospital, where he underwent emergency surgery for clots in his leg. The Patient’s left leg was removed above the knee four days later. After this removal, the Patient and his wife complained to the HCCC about the Nurse’s conduct on the evening of 23 December 2009.


In summary, the complaint alleges that the Nurse failed to complete a thorough assessment of the Patient; that the Nurse failed to create an adequate record of the consultation; that the Nurse failed to discuss the Patient’s presentation with a medical officer prior to indicating to the Patient that he could leave the hospital and failed to request a medical officer to examine the Patient; that the Nurse failed to dispense medication (namely, the two Panadeine Forte tablets) in accordance with NSW Department of Health Policies; and that the Nurse dispensed medication (namely a box of Panadeine Forte) without a medical officer’s order or prescription, thereby operating outside her scope of practice as a registered nurse.