A Wagga nurse has been suspended and another cautioned after they were found to have engaged in unprofessional conduct when a patient under their care complained numerous times of suffering severe pain leading up to his death.
In a judgment last Friday, the NSW Civil and Administrative Tribunal found that former Wagga Base Hospital nurses Jennifer Hogg and Breanna Lord behaved inappropriately and unprofessionally towards a 75-year-old man on February 15, 2017.
Another patient sharing the room was so concerned about their treatment that he used his phone to make a 20-minute recording, which the tribunal described as "disturbing listening".
The 75-year-old, who had knee surgery five days prior, was in the nurses' care starting from 2pm and was pronounced dead at 10.27pm.
An autopsy showed the cause of death was ischemic heart disease.
Throughout the recording, the patient - who had symptoms of nausea, vomiting and breathlessness - could be heard groaning, moaning and repeatedly saying he was falling and fainting.
Ms Hogg and, to a lesser extent, Ms Lord can be heard rebuking the patient for being "uncooperative".
You're not even close to dying so don't even try.Jennifer Hogg
On that day, Ms Hogg was the designated nurse in charge of the afternoon shift while Ms Lord was a new graduate nurse.
The patient asked for help multiple times in relation to abdominal pain and needing to go to the toilet.
Ms Hogg, who at times raised her voice and shouted at the patient, ordered him to go to the toilet a number of times.
At one point, Ms Hogg only agreed to giving the patient medication early after Ms Lord told her twice that he had "significant abdominal cramping".
Later that night, Ms Lord and Ms Hogg took him to shower after they found him having soiled himself.
Among the things Ms Hogg said to the patient were "you s--- on the floor, you need to sit up" and "you're not even close to dying so don't even try".
She also said "stop being dramatic" and "it's his fault he s--- himself". Ms Hogg also told the patient he did not need knee surgery because "it's not life or death".
Just before 10.30pm, the patient died after attempts to resuscitate failed.
'Bullying, aggressive and belittling'
The complaints about Ms Hogg and Ms Lord were referred to the tribunal by the Health Care Complaints Commission.
After a one-day hearing in October, the tribunal found Ms Hogg failed to respond appropriately and failed to maintain adequate nursing notes about the patient's deterioration.
She also spoke to the patient in an unprofessional manner and failed to provide adequate help and guidance to Ms Lord, who was only in her second day in the ward.
Of the nine particulars, Ms Hogg admitted to seven and disputed one. She also admitted that the way she spoke with the patient was "nothing short of appalling".
In reaching its decision and orders, the tribunal said Ms Hogg's conduct, particularly during the shower incident and her failure to adequately respond to the patient's deterioration is "sufficiently serious" to justify suspension or cancellation of her registration.
"Her tone was bullying, aggressive and belittling. The statements made were entirely unacceptable," the tribunal said.
The statements made were entirely unacceptable.NSW Civil and Administrative Tribunal
The tribunal said that the impression likely to have been conveyed to the patient "was that because he had elected to have knee surgery, he was not entitled to voice complaints of pain and discomfort and that by 's----ing himself' he was sub-human and disgusting".
The tribunal accepted medical evidence that Ms Hogg's bipolar disorder contributed to the offending.
Evidence also showed that Ms Hogg has had positive rehabilitation that has led to her psychiatric condition remaining stable.
She told the tribunal she was deeply remorseful and ashamed of her actions. Her nursing registration was suspended for six months from the tribunal decision.
Numerous conditions have also been imposed on her registration and she was ordered to pay 90 per cent of the commission's legal costs.
'Unable to express my concerns'
During the hearing, Ms Lord admitted to all the allegations against her but claimed she felt "unable to express my concerns" because Ms Hogg said the patient was fine.
The tribunal found that she also spoke without empathy and respect towards the patient.
During the shower incident, Ms Lord raised her voice and said: "What are putting your hand out for? I'm not helping you. I'm not pulling you up".
Ms Lord's response to the patient and nursing notes were also found to be inadequate. She only made a note after the patient died.
"The impugned conduct was not in the nature of an occasional inappropriate or gratuitous comment," the tribunal said.
It said a caution "sufficiently denounces Ms Lord's conduct" and that it was satisfied that Ms Lord was genuinely remorseful.
Both women were represented by the NSW Nurses and Midwives' Association during the hearing. An association spokesperson said the organisation does not comment on individual matters.
The Daily Advertiser has asked to be put in contact with both women.
A Murrumbidgee Local Health District statement reads that Ms Hogg and Ms Lord are no longer employed by the district since 2017.
The MLHD "has clear standards of ethical and professional conduct for every employee", the statement reads.
"In accordance with the NSW Health Code of Conduct, behaviours which are unacceptable will not be tolerated."