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Director of Proceedings v Torrance – Registered Nurse

Health Practitioners Disciplinary Tribunal, Nur09/138D

In a decision dated 8 June 2010 the Health Practitioners Disciplinary Tribunal found Registered Psychiatric District Nurse David Graeme Torrance (known as Graeme) guilty of professional misconduct. This case concerned the care Mr Torrance provided to two of his clients who were living in a flatting situation together. Both were long-standing clients of Waitemata District Health Board's Community Mental Health Service and each had a well documented history of early warning signs of unwellness with which Mr Torrance, who had cared for those clients for a number of years, was familiar.

One client, Ms N, had a long history of receiving care from the Community Mental Health Service, including a package of care which assisted with activities of daily living. Of significance, Ms N had also previously experienced debilitating anxiety, distress and unwellness in relation to having to move house.

Mr Torrance's other client, Mr R, had in the past experienced significant episodes of psychosis which on occasion had resulted in his being hospitalised under compulsory treatment orders under the Mental Health (Compulsory Assessment and Treatment) Act.

Mr R's dose of anti-psychotic medication was reduced from 25mg to 20mg on 19 March 2007. Following that reduction Mr R's condition gradually deteriorated with him experiencing delusional thoughts and displaying disturbed behaviour. In response to the stress arising from Mr R's deterioration Ms N's condition also deteriorated, this then being exacerbated by stress she experienced due to impending eviction from their home at the end of 2007. In late December 2007 Mr Torrance went on leave and when he returned he found his clients had been evicted from their home and that Ms N had gone missing.

 On 7 January 2008 Mr R was located by the police and Mental Health (Compulsory Assessment and Treatment) Act proceedings begun. Mr R was found to meet the criteria for Compulsory Assessment and Treatment and was admitted into an acute psychiatric ward. After extensive search efforts, Ms N's body was recovered on 20 January. She had taken her own life.

It was alleged that in the course of caring for his clients between 2 March 2007 and 3 January 2008 and following his decision to reduce Mr R's dose of antipsychotic medication in March that year, Mr Torrance failed to undertake adequate assessment of risk to his clients and failed to adequately manage that risk in that he failed to arrange timely psychiatric reviews for his clients, failed to plan or conduct adequate follow-up care for them, that he failed to adequately respond to concerns raised by his clients' families about their wellbeing, that he failed to engage assistance of appropriate members of the broader DHB care team in managing those risks, that he failed to provide relevant information to appropriate members of the care team in a timely manner, and that he failed to adequately document the care he provided to his clients. Furthermore, it was alleged that when Mr Torrance went on leave in late December 2007 he failed to develop an adequate plan of care or undertake an adequate handover of care to other staff.

Mr Torrance admitted the charge against him and the matter proceeded by way of an agreed summary of facts.

Expert evidence called by the Director of Proceedings set out the appropriate nursing standards with the expert opining that Mr Torrance's numerous failures amounted to departures from accepted standards, some of which were extremely serious.

The Tribunal found that all but one of the particulars of the charge (regarding the decision to reduce Mr R's dose of anti-psychotic medication) amounted to professional misconduct in their own right and that when viewed cumulatively the entirety of the failures amounted to professional misconduct. In reaching its decision the Tribunal noted that the standard of care Mr Torrance provided Mr R and Ms N fell well below the standard expected of a registered nurse and that given the extremely serious nature of the charges and the issue of public safety it had no option other than to cancel Mr Torrance's registration.

The Tribunal ordered that Mr Torrance pay $20,000 toward the Director's costs and $10,000 toward the costs of the Tribunal's hearing, and ordered that before he may apply to return to registration Mr Torrance undertake a course of study approved by the Nursing Council in regard to management of risk and that on return he practise under the supervision of a registered nurse appointed by the Nursing Council. An application for an order permanently suppressing Mr Torrance's name was declined.

The Tribunal's full decision can be found at:

http://www.hpdt.org.nz/Default.aspx?tabid=254